Scenario in English

• A patient visited a dental clinic to make a fixed denture. His right

maxillary lateral incisor had been extracted few months ago caused
by an excessive caries. He wanted to make denture like his friend’s,
which has a fixed prosthesis with only a little part of the tooth being
prepared so that the anterior part of the tooth was not prepared at
all. He does not bother about the cost of the treatment.
Problem
1. Etiology in this case
2. diagnosis
3. Examination before treatment
4. Alternative treatment for patient
5. What are the type of treatment
6. treatment planning
7. Indication and contraindication of treatment
8. Advantage and disadvantages
9. Material of the treatment
10. How to do preparation, so the tooth not to prepared at all ?
Etiology in this case
Because extracted (excessive caries). Maybe other case: trauma,
systemic disease (DM-periodontitisloose his teeth)
diagnosis
• missing maxillary lateral incisor et causa caries
 Examination before treatment
• CC
cause the tooth was missing
experience of using denture
lifestyle
• Medical History. Risk assemssnt
• Dental History
restorative history
periodontal history
Endodotic
Removable prosthodontics histroey
• Intraoral
periodontal condition, alveolar bone
address to vestibular and palatal depth. Occlusion, jaw relation
Parafunctional habit.
look the abutment teeth condition
Soft tissue lesion
• Ekstraoral. TMJ and mastication muscle.
• Radiography examination
ensure the alveolar bone condition
use periapical /panoramic
quality and quantity of bone
Esthetic consideration. Smile line for the position of the upper lip.
Alternative treatment for patient
1. Maryland bridge
Minimally invasive treatment alternative for replacement the missing teeth
Using in the anterior teeth
Using resin bond for retainer, offer to individual who don’t have cavity surrounding teeth
Fixed denture beside resin bonded,
Minimal preparation, only enamel get prepared but get good result
Like a “Flying boat”
Have metal wing (preparation in labial/palatal) metal
Design (ibnu) : using MCR retainer

Advantges : aesthetic satisfactory. affordable cost, pulp trauma is minimal because the anesthesia is avoided. Abutment teeth are not
damaged. less periodontal lesion result in comparison with conventional bridge

Give more retention use to many material

Bridge (conventional) :prosthetic treatment for change the missing teeth. All of abutment teeth should be prepared

2. Fiber reinforce composite

. Have a good strength and good aesthetic also minimal preparation.
3. Rochette bridge
4. Virginia bridge

(Cost reduction. Minimal preparation more conservative less ligthly to create problem in umblamised abutment teeth
• Component of bridge. (Retainer connector pontic)
type. Fixed-fixed bridge (2 or more abutment teeth)
simple cantilever (don’t have connector)
Maryland (example of resin bonded retainer??). Marker on the
palatal of abutment.
What are the type of treatment
• Maryland bridge
treatment planning
• Preparation
establish lingual clearance
reduce of lingual heigh of contour
create incisal finishing line
develop cingulum rest seat
establish interproximal finishing line
place the proximal retentive groove
expect limited 0,5 mm after preparation
Restricted in the lingual surface or less of enamel later
record the use putty. The choose material and do mock up
• Treatment planning
• Examination clinical situation
• Option of material
• Choose the fixed denture.(use Maryland bridge)
• Prosedure
• Diagnosis condition
• Taking impression
• Marker the abutment then do preparation
• Dental Mould
• Send to dental lab, then try in to the patient
• Cementation
ensure the ratio of the crown and root length abutment teeth to increase bonding area.

Factor for selection abutment teeth:

- Periodontal condition of abutment teeth. No periodontal disease
- Bonding surface area. Must be large surface area
- Restorative status. Abutment teeth have good quality condition
- Endodontic status.
- Angulation
- position
Indication
• Contraindication
and contraindication of treatment
- the case involving deep class to occlusion
- bad habit (bruxism)
- inadequate posterior support.
- periodontally compromise abutment teeth
- inadequate enamel for bonding
- distance too long
- crowded teeth
-. Carious abutment
- sensitivity to nikel
- deep bite
- severely procline front teeth. Which are more to trauma
- poor clinical enamel
- short clinical crown
- little space because crowding and several missing teeth in anterior
• Indication
- replacement of single missing teeth
- missing teeth anterior
- healthy oral cavity and good maintenance
- good height and sound abutment teeth
- abutment teeth are inside the arch
- sufficient crown high due to providing good retention
- tooth in arch curve facture
- good moisture control
- extracted anterior teeth. Because perodonal, carious, congenital
(generally lateral incisor)
Advantage and disadvantages
• Advantages
- Minimal tooth preparation
- Involving removal of less than half of coronal structure
- Feel comfort, no anesthesia, pulp trauma is minimal
- High aesthetic
- Less risk of sensitivity and pulp exposure
- Margin of the wing above of gingival. Easy removal of the plaque. Good in oral hygiene
- Economic. Lower cost.
- Easy and quick preparation
- Retainer be thinner
- Oral surface of the cast retainer is highly polished
- Reduced time for patient and operator.
- Easy to maintenance OH
- No need anesthesia
• Disadvantages
- limited . Not use for commonly tooth replacement.
- Cannot be placed if little space is available
- compromise aesthetic in posterior where metal use for higher strength
- some cases, plaque accumulation. The Desain
- high risk of failure
- longetivity is smaller than other option treatment
- poor alignment of teeth. Associated with higher risk of failure
-metallic appearance
Material of the treatment
Use resin composite for pontic. Porcelaine, zyrqonia
retainer,. Use metal, zirconia

Material of pontic.
Metal ceramic is the best option. Stronger than other.
Wing. Use metal

cementing use GIC type 1. or resin

How to do preparation, so the tooth not to prepared at all ?

• Marker the abutment then do preparation

• Dental Mould
• Send to dental lab, then try in to the patient
• Cementation

Step preparation
1. Establish lingual clearance. Determine lingual preparation area and the deep of preparation
2. Reduced lingual height of contour with reduction of lingual area. Se diamond bur with deep of 0,6-1 mm
3. Create incisal finishing line. Preparation edge approximately to milimiter of incisal
4. Develop cingulum rest seat. Purpose, provide retainer durability in position, increase retention in plantation result.
5. Establish interproximal finishing line
6. Finishing proximal retentive groove. To Increase retention

Preparation not smooth surface, but there is a roughness for cementation