Prosthodontics

Lesson objectives

✓ Impression materials
✓ Different types of crowns
✓ Different types of bridges
✓ Dentures, stages for constructions and
materials
✓ Other removable prosthodontic
devices
✓ Orthodontic appliances
 Prosthodontics

Prosthodontics is a branch of dentistry involving:

▪ restoration of damaged teeth – crown
▪ replacement of missing teeth – dentures, implants, bridges

Artificial devices – crowns, bridges, dentures (prostheses)

Fixed - cemented into place permanently (implants, crowns and bridges)

Removable - can be removed from the mouth by the patient (dentures)

Dental Technicians - they follow the morphology of the tooth to

construct a unique restoration to fit the patient’s mouth.
The teeth must be prepared by the dentist.
 Impression materials used in dentistry

1. Irreversible hydrocolloid = (Alginate)

2. Addition silicones and vinyl polysiloxanes
3. Polyethers

Used to create an accurate copy of patient’s mouth, for the technician to

work on.
 Impression materials

Alginate impressions can be used for:

• Study models
• Construction of full and partial dentures
• Construction of removable orthodontics appliances and retainers
• Construction of whitening trays
Alginate must be handled with care:
• If left immersed in water the impression expands
• If allowed to dry out , the impression shrinks
• Impression should be wrapped in damp gauze
• Alginate → not a very accurate material

Silicone impression materials:

• Putty + lightbody (WASH) or Polyether material
• Also called - Elastomer impressions
• Highly accurate when set
Impression disinfection

• Rinsed under cold water to remove debris

• 1%-10% sodium hypochlorite solution
• 10 minutes
• Rinsed again to remove chemicals
• Wet gauze- alginate
• Dried and dry tissue- elastomer
• Room temperature or below
Impression trays
• Boxed impressions trays
• Special trays (denture construction)
• Triple trays
• Metal trays
• Edentulous impressions trays
Crowns
 Instruments and materials used
Occlusion registration (bite registration)
• To record the exact position of the upper teeth and lower teeth when
the patient bites together.

Gingival retraction cord/paste → will cause the gum to retract away

from the tooth and therefore allowing the impression material to record
the tooth margins.

• Diamond burs and handpieces

• Impression materials and trays
• Shade guide
• Pages 606 - 610
 Types of crowns
• Porcelain jacket crowns- best for anterior teeth, cosmetic treatment
• Ceramic crowns- zirconia, very aesthetic, strong and conservative (Emax)
• Porcelain bonded crowns – very strong, with metal underneath, may not be very
aesthetic
• Full gold crowns- made of dental gold, best for posterior teeth, very strong
• Metal crowns – same as gold ones, the colour differs

Luting cements at page 610

 Post-crowns
• A crown's stability depends on the amount of tooth structure left.
• Sometimes, root treated teeth can fracture, and if the fracture is
too extensive, the remaining tooth would need additional support to
hold a crown on top.
• The post- core procedure consists of the insertion of a small rod
into the root space of an affected tooth. (acts as an anchor)
 Temporary crowns
• Temporary crowns are used between visits:
• To maintain appearance
• To prevent sensitivity
• To maintain correct occlusion

• Materials - acrylic, plastic, polycarbonate, stainless steel

or aluminium. (page 614-615)
Veneers
• Used on anterior teeth only for
various aesthetic reasons
• A veneer is similar to a false
fingernail; it is a thin layer of
porcelain (only 0.5mm thick)
• They are not strong enough to
withstand the biting action of
the molars.
Inlays/Onlays

• Look very similar to a filling consisting of a solid

substance (as gold or porcelain) fitted to a cavity in a
tooth
• Fit appointment is required, and a luting cement is used
to stick them in place.
• An onlay is the same as an inlay, except that it
incorporates a replacement for a tooth cusp.
Dental bridges
 Fixed-fixed bridge

When retaining teeth are

involved to either side of the
missing teeth, as one solid
design.
 Fixed-moveable
bridge

When a joint is incorporated in the

design to allow some degree of
flexibility of the bridge
 Cantilever bridge

Where the retaining tooth/teeth are to one

side of the pontic

Simple cantilever
Spring cantilever
 Adhesive bridge
(Maryland)

Where the retaining teeth undergo

minimal tooth preparation and retention
is provided by lingual or palatal metal
wings only.
 Oral hygiene advice

For crowns – general oral hygiene advice,

careful using of floss and to avoid sticky foods.

For bridges – general oral hygiene advice and

use of superfloss to clean under the pontic
area

Page 621
Removable prostheses

❖Full denture
❖Partial dentures

❖Acrylic dentures
❖Chrome cobalt dentures
 Types of dentures
dentures
Acrylic dentures:
Acrylic consists of a powder called polymer and a liquid
called monomer.
Full dentures – replace all missing teeth in one arch
(edentulous patients)
Partial dentures - replace one or more missing teeth and
can rely on clasps for retention.

Chrome-cobalt dentures:
• The base of the denture is made of metallic alloy chrome-
cobalt.
• They are more expensive than acrylic ones, but much
stronger
• They are more tolerable to patients
• As less tissues coverage is involved , chrome cobalt
tends to be more hygienic than acrylic one.
Denture construction stages

▪First impression – using stock trays and alginate

material
▪Secondary impression – using special trays and either
alginate/elastomer
 Denture construction stages

• Bite registration – the existing or required occlusal face

height of the patient

• Wax rims
• Wax knife
• Heat source
Denture construction stages
 Denture construction stages

▪Fit stage – check for comfort, fit and aesthetics.


Advice on cleaning, wearing and
maintaining the denture
▪Patient should clean them after every meal (if they wear partial
dentures the rest of the teeth to be brushed)
▪Clean over a bowl of water to avoid damage in case it is dropped
▪Soft foods initially
▪If they cause discomfort, patient to return to the surgery
 Immediate dentures

• If the patient has teeth to be extracted and

there is a need to maintain appearance and
function, an immediate denture will be the
option.
• Fitted on the same day with extractions
• No try in or bite stages involved
Methods of replacing missing teeth

Conclusion:

1. Dental bridges
2. Dentures (partial or full)
3. Implants - a titanium double-screw cylinder inserted
into the alveolar bone

An implant can be used to support a crown, a bridge or a

denture.
Orthodontic appliances

Orthodontic appliances are used to correct the

position of the teeth (to align, move or straighten)

Fixed appliance - they consist of brackets and arch

wires, elastic rings or ligatures.

• The brackets can be made of metal or ceramic

• It cannot be removed by the patient.

• Instruments: pages 641, 642

Functional and removable appliances

Functional appliance - worn on both arches at the same time.

• The commonest functional appliance is the Twin block- (a
functional appliance to correct class 2 problems) – relies on
modifying the growth pattern of the mandible in a growing child.

• Aligners (Invisalign) – exert gradual pressure (used as an

aesthetic alternative)
Oral hygiene – fixed appliance

• Brush teeth and appliances after each meal. Ideally, 3

times a day
• Clean each tooth individually for about 10 seconds.
• Clean around the fixed appliance.
• Floss between teeth daily using a ‘threaded’ floss.
• Interdental brushes to be used
• Fluoride toothpaste and mouthwash
• Disclosing tablets
• Well-balanced diet

• Page 643
• Page 644, 645, 646
 Retainers

• To prevent the teeth moving back to their

initial position.

Fixed – wire retainer

Removable
• Essix retainer
• Hawley retainer
Levison’s textbook: chapter 16
Q&A book: chapter 10a