Ahmed M.

Leithey Alameldin

Basic Fixed Prosthodontics

By
Dr. Ahmed M. Leithey Alameldin

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Diagnosis and Treatment planning

 Personal Data:
Get to know your patient well, you will start to know the
needs of this particular patient.
You start to establish the relationship with your patient at
this stage.
Know your patient’s name, age, gender, marital status,
job ….. etc.

• Start with medical history.

• Some patients may say we complain of nothing, ask
them about their past medical history, then come back
to ask about the current medical status.
• Some diseases may require alteration of the treatment
plan or the design of the restoration.
• A Patient with Xerostomia will require the dentist to
place the margins of the restoration subgingivially.
• A Patient subject to Osteoradionecrosis (Radiotherapy
within the last six month) should not undergo surgical
procedures. Ex. Surgical crown lengthening.
• Controlled Hypertensive and diabetic Patients will need
the dentist to practice Stress Reduction Protocol.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

This involves:
• Avoiding lengthy appointments. (Short
appointments no more than 30 mins.)
• Morning appointments.
• Atraumatic technique.
• Pain-free injections.
• Being calm and assuring to the patient.
• Simplify the procedure.

• Some Uncontrolled diabetic Patients may suffer from

periodontal breakdown. Soft-tissue management and
no violation of the biologic width is mandatory.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• In general if the sulcus probes 1.5 mm or less, the

restorative margin can be placed 0.5 mm below the
gingival tissue crest.
• If the sulcus probes more than 1.5 mm, the restorative
margin can be placed in half the depth of the sulcus.

• Proceed with Dental history.

• Ask about past dental history, then ask about the
current dental status.
• Some patients would like to jump to the chief
complaints directly, AVOID THIS.
This will not help you formulate a correct treatment
planning, and you may miss some critical information
that may complicate the case for you.
This will give you important information on:
– Patient's dental status.
– Previous treatments and failures.
– Patient’s expectation and priorities.
– Treatment planning.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Objectives of
prosthodontic treatment
Restoration of
Elimination of Preservation of
function and lost
disease health
teeth

Patient’s Chief Complaint

• Listen to the patient’s own words.

• Avoid asking leading questions.
• Ask open ended question.
• What brought him to seek dental treatment.
• Knowing the level of patient’s dental awareness and
quality of care expected.
• Ex. If you need to educate the patient about the
treatment or the post operative care or what or what to
expect.
• See if the patient will be cooperative or simplify the
treatment.
• Esthetic results anticipated by the patient.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Clinical examination
• Do a quick extra-oral examination.
• When planning a case with esthetic makeover pay
attention to the extraoral examination.
• Ask the patient to open up, observe the maximal mouth
opening.
• Normally it should be around 45-50 mm.
• If less than 40 mm consider a limited mouth opening.
• Examine the TMJ. Patients with sever TMJ dysfunction
can not have lengthy appointments.

• Proceed with intraoral examination.

• First the patient’s general oral hygiene is observed.
• Presence or absence of inflammation.
• Examine the edentulous ridge.
• Check any existing restoration. You may need to re-do it
or include it in the prosthesis.
• Check the occlusal surface of all teeth, are there wear
facets?

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• Check for supra-eruption of opposing teeth and plunger

cusp effect. (Ex. Palatal cusp of upper 6)

Abutment evaluation

Remaining sound tooth structure.

Missed areas of coronal tooth structure.
Dental caries.
Previous restorations (adequate, inadequate, to be used or
replaced).
Extent of the defect (Supragingival or subgingival)
Ideally, a vital abutment is more preferable.
Endodontically treated teeth can be safely used as
abutments for single crown.
Endodontically treated teeth as abutments for bridges are
questionable.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

When in doubt, do an elective endo or wait and see.

Inflamed gingiva will bleed and make impression taking
inadequate.
Faulty margin placement and wrong shade selection.
Adhesive cementation is nearly impossible with inflamed
gingiva.

Mobile teeth may not be able to support any span under

occlusal load.
Crestal bone level is crucial to many considerations.
Optimal crown-root ratio is 2:3. Whereas the minimal is
1:1.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

For long span bridges, the ratio is to be considered with

other factors, ex. Periodontal surface area, span length,
root configuration.

Root configuration
Roots which are wider bocco-lingually than mesiodistal
can handle occlusal load more than conical roots.

Multi-rooted posterior teeth are better abutments than

teeth with conjoined roots.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Periodontal surface area

(Ante’s law)

Periodontal surface area of abutment teeth should be 

greater than or equal to the periodontal surface area of
the missing teeth.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• Double abutments are sometimes used as a means of

overcoming problems created by unfavorable crown-
root ratios and long span.
• A secondary abutment must have at least as much root
surface area and as favorable a crown-root ratio as the
primary abutment.
A canine can be used as a secondary abutment to a first
premolar primary abutment, but it would be unwise to
use a lateral incisor as a secondary abutment to a canine
primary abutment.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• When the pontics lie outside the intra-abutment axis

line, the pontics act as a lever arm which can produce a
torquing movement.
The first pre-molars some times are used as secondary
abutments for maxillary four-pontic canine-to-canine FPD.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Treatment Plan

1. Disease control phase:

* Endodontics. * Oral surgery. * Caries control.

2. Periodontal phase:
* Scaling / root planning. * Perio surgery. *Improved
patient homecare.

3. Restorative phase:
* Operative. * Fixed prosthodontics. *Removable
prosthodontics.

4. Maintenance phase:
* Periodontal. *Restorative. *Radiographs.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Cantilever bridge

Abutments should be evaluated for lengthy roots with a

favorable configuration, good crown root ratios and long
clinical crowns.
Cantilever FPDs should replace only one tooth.

A cantilever can be used for replacing a maxillary lateral

incisor with canine as the abutment. There should be no
occlusal contact on the pontic in either centric or lateral
excursions.

Cantilever can be used to replace a missing 1st premolar with

2nd premolar and 1st molar as abutments.
Occlusal contact should be limited to the distal fossa on the
1st premolar pontic.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

All ceramic restorations

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Guidelines of tooth preparation

• Do an anatomical preparation.
• Removal of adequate amount of tooth structure.
• Enough occlusal or incisal clearance.
• Roundation of all line- and point-angles.
• No sharp lines or irregularities.
• Well definite finish line.
Not only for marginal integrity, but for structural durability of the
restoration
• Respect the Anatomy.
• Prepare the facial surface of anterior teeth on two plains.
• Do the functional cusp bevel in posterior teeth.
• Preserve as much tooth structure as possible.
• Presence of optimal tooth height.
• Even though we bond most of these restorations, they have to
have adequate retention on their own.
• Preserve enamel for resin bonding.
• Don’t make your ceramic bulk over 2 mm.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Criteria of anterior all ceramic crown tooth preparation

Finish line
0.7 - 1 mm Shoulder (Radial shoulder)
Equi-gingival or 0.5 mm sub-gingival
Smooth – continuous - even thickness
Follow gingival contour

Axial reduction
1 – 1.5 mm
Facial surface on two plains
Smooth – Rounded – No sharp lines
Give adequate clearance for centric contacts on the palatal of upper
and the facial of lowers

Incisal reduction
1- 1.5 mm
Slight palatal inclination of the incisal edge
Smooth – Rounded – No sharp lines

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Criteria of posterior all ceramic crown tooth preparation

Finish line
0.6 - 1 mm Shoulder (Radial shoulder)
Supra-gingival or equi-gingival
Smooth – continuous - even thickness
Follow gingival contour

Axial reduction
1 mm
Facial surface on one plain
Parallel to long axis of the tooth
Smooth – Rounded – No sharp lines

Occlusal reduction
1 - 1.5 mm
Planar reduction – Functional cusp bevel
Smooth – Rounded – No sharp lines

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Tips for proper shade selection:

• The first step prior to Preparation; dehydration will

cause the shade to be too whitish.
• Teeth should be clean. If not, do prophylaxis.
• Don’t dry tooth surface. Always keep the tooth naturally
moist.
• Switch off the light of the dental unit.
• Use natural daylight if possible.
• Imply the 5-second rule.
• Use a neutral patient towel (blue or grey, never yellow
nor pink).
• Ask the patient to take off their eyeglasses, specially if
they are tinted.
• Match the shade using the appropriate Shade guide the
lab uses.
• Do a shade map for each tooth.

• Patient’s back reclined 45º.

• Observe the shade at an arm-length distance.
• Patient’s corner of the mouth at the level of dentist’s
eye.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• Determine the value first (lightness)

• Select group 0,1,2,3,4 or 5.
• Start selection with darkest group first.
• Hold the shade guide at arm’s length at patient’s teeth.

• Then determine Chroma.

• Select the middle hue (M) in the group selected (ex.
3M).
• Spread samples out like a fan.
• Select one of the three samples

• Determine the Hue.

• Check if natural tooth is more reddish (R) or more
yellowish (L) compared to shade sample selected.

Ahmed M. Leithey Alameldin