Partial edentation. Etiology and pathogenesis of partial edentation.

Clinic of
partial adentia.

The partial edentation

may be defined as the absence from 1 to 13-15 teeth on one dental-alveolar arch.
Local and general influence of defects on the organism
a) various forms of the maxillodental system pathology, like:
- disturbance of mastication function

- cosmetic defects

- migration of remained teeth

- incorrect bite

- modification of alveolar processes

- changes in mucous membrane

- changes in the height of occlusion occur as a result of increased dental abrasion

on the large area

- the teeth, which do not have antagonists, may cause injury and inflammation of
the mucous membrane of the alveolar processes of the opposite jaw.

b) local-regional changes:
- functional and the morphological changes in the temporal- mandibular joint

- disturbances of the mastication result in changes in the functional activity of the

salivary glands

c) atrophic- degenerate processes development lead to changes in the

gastrointestinal tract, nervous system.

Researches made by our cathedra has established that partial adentia in Moldova
consists 611 people from 1000 moldavian population (and in the country –
653; in the city – 599 from 1000; and more often it can be met at men
population).
Analysing received results incidence of partial edentation according to Kennedy
classification was established that:

I class – 87,8 patients from1000 people

II class – 67,9 patients from 1000 people

III class – 430 patients from 1000 people

IV class – 25 patient from 1000 people.

South zone – 711 from 1000 people, Central zone – 626 from 1000 people,
North zone – 538 from 1000 people.
Ethiological factors of partial edentation theoreticaly can be divided into:

congenital factors (abcence of tooth bud or their distruction at the begining of their
embryonic developing) begin influence from VI week of intrauterin life. In this
group of factors also enter disorders of teeth eruption, resulting in impacted teeth.

obtained factors:

- caries and dental decay – a destructive chronic process

- tooth inclusion: a) complete: profound or superficial

b) partial (more often the third lower molar, upper canine,

premolars and incissives)

- periodontal diseases

- operation because of different tumors

- trauma

- avitaminoses

- different general deseases (diabetes, hypertonia and others)

- iatrogenia

- social-economical causes etc.

The pathogenesis of partial secondary adentia
depends on etiologic factor, associated diseases, age ...
Classification of partial edentation by Edward Kennedy (1925):

Kennedy classified the clinical forms of partial edentation depending the

topographical principle:

I – the bilateral adentia, where the edentulous area is limited by the teeth only
medial.

II – unilateral adentia where the edentulous area is limited by the teeth only
medial.

III – the edentation area is situated in lateral arch’s zone being limited by the teeth
medially and distally.

IV – the edentation area is situated in frontal arch’s zone being limited by the teeth
distally.

He added the modifications of the edentation classes. First three classes have four
subclasses, depending on number of edentulous zone in principal class.
Classification of partial edentation by Kennedy-Applegate

Kenedy classification was completed by Applegate with two another classes

including subtotal edentation:

Class V edentulous area bounded anteriorly and posteriorly by the natural teeth
but in which the anterior abutment is not suitable for the support.

Class VI – edentulous situation in which the teeth adjacent to the space are capable
of total support of the required prosthesis.

Classification of partial adentia by Costa (by topographical criterion):

I – absence of one or all frontal teeth, the edentulous breach being distal limited by
the teeth

II – the edentation situated in the arch’s lateral zones (uni- or bilateral), the
edentulous breach being medial and distal limited by the teeth (absence of
 premolars or molars)

III – the uni- or bilateral edentation where the edentulous breaches are only
medial limited by the teeth (absence of molars and may be premolars too)

IV – mixt edentation – edentulous breaches are situated in different zone in

absence of more teeth

V – extended edentation in frontal and lateral zone

VI – subtotal edentation (presence of one or two teeth).

Clinic of partial edentation will be individual and depends on:

- number of lossing teeth

- topography of dental arch defect and role of loosing teeth

- condition of hard tooth tissues and periodontium of remained teeth

- type of occlusion

- time passed after tooth extraction

- etiological factors of partial edentation

- patient’s age and his general condition of the body etc.

The extra-oral symptoms can be absent or can appear:

a) depending on number of lost teeth and topography of defect

b) depending on localization and length of partial edentation

Intraoral symptoms:

- defect of dental arch in one or two jaws (disorder of one or two dental arch
integrity);

dental arch disintegrate because of appearing two groups of the teeth:

a) functional

b) nonfunctional
- different type (vertical, horisontal) of migration of remained teeth

- functional overloading periodontium of remained teeth

- deformation of occlusal surface of dental arch

- changes in function (biting, mastication, swallowing, grinding, phonetic, from the

TMJ, muscles)

- changes of the buccal mucosa.

Treatment of patients with partial adentia

is carried out with Partial Fixed Denture, Partial Removable (Acrylic, Elastic and
Skeletised (or Arch) Denture and Fixed or Removable Denture on
implants.

Choising the construction of denture and support teeth is made taking into
consideration the type and extension of PA, condition of periodontium of all
remained teeth, tonus of the mastication muscles, some professional habits of
the patients, the type of occlusion, intermaxilar relationships, general
condition of organism etc.
Components of diagnosis at partial edentation

- the anatomo-clinical diagnosis (partial primary (secondary) edentation);

- the topographical edentation (on the upper or lower jaw);

- the diagnosis of the clinical form of the edentation, indicate class of the
edentation (Kennedy-Applegate, the Lejoyeux classes);

- the etiological diagnosis (cause that lead to teeth lossing: congenital etiology,
trauma, tumors etc) or dento-alveolar disharmonies (vicious habitsm traumas
etc);

- the functional diagnosis (functional disturbances of the stomatognat system:

mastication, physiognomic, phonetic);

- the evolutive diagnosis will specify the way in which the edentation appeared
(slow, suddenly, step by step);
- the diagnosis of complications of the partial edentation (existence of local or
general complications);

- the prognoses of the partial edentation varies according to the clinical form,
etiology, possible complications;

- the diagnosis of the therapeitical stage will indicate the stage of the treatment.

Clinical and para-clinical examination of patients with partial adentia.

Examination of defects of dental arches and dental-periodontal support. Kinds of
clinical situations at PA. Morphological and functional changes in stomatognat
system.

Clinical examination of the patient it is necessary for determination correct

diagnosis and plan of treatment depending on every clinical situation.
Sequence of clinical examination of patients with partial adentia

The process of clinical examination involves two stages:

- medical examination

- oral examination

A) subjective data

B) objective data:

- extra-oral examination

- intraoral examination
Subjective data includes:

Personal data.

Causes of patient addressing to the doctor (complaints and their history).

Patient medical history (general and concomitent diseases).

History of disease.

Patient expectations.
More often subjective symptoms:

pain

alveolar hyperaesthesia

functional insufficiency:

*changes at mastication

*phonetical changes

*the insufficiency of the physiognomic function

*the insufficiency of the deglutiotion function

- static and dynamic disbalance of stomatognat system

- nevrosis and others symptoms.

Also there are may be local (pulpitis, periodontitis, parodontities, etc.), loco-
regional (in the TMJ, muscles) and general complications (digestive tract,
NS).
Extra-oral examination

is made: a) by visualisation;

b) by palpation;

c) by sounding
Intra-oral examination:

is made: a) by visualisation

b) by palpation

c) by percution.

Sequence of examination:
1. Vestible mucosa examination

2. Teeth examination

3. Examination of tooth arches and occlusion:

- shape of dental arche

- presence, size, quantity and topography of toothless spaces

- presence, character and condition of existent dental prosthesis

- character of occlusal curve

- correlation between each tooth and occlusal curve.

4. Examination of residual ridges

5. Investing structures examination

6. Oral cavity mucosa and salivary glands and

7. Oral hygiene iindex examination.

Para-clinical methods of examination of the patients

X-ray examination: a) simple oral X-ray; b) ortopantomography; c) tomography;

d) telerentgenography; e) cineradiography; f) rengenography of the TMJ; g)
electroradiography

B) analysis of diagnostic models;

C) analysis of mastication muscles:

a) palpation; b) electromyography; c) definition of chewing efficiency

D) reoparodontography;

E) examination of occlusiogramm

F) TMJ examination

J) polarography

I) ehoosteometriya

K) morphological study
L) cytological method

M) biopsy

N) microscopic examination

O) bacteriological examination

P) immunobiological study

R) complete blood count

S) biochemical blood and urineetc.

Kinds of clinical situations at partial adentia:
I - includes tooth rows with remained teeth antagonists (fixed height of bite) and
they are located in such a way (at three points (in the form of a triangle) in anterior
and posterior right

and left sides), that it is possible to fix the models in position of centric occlusion,
guiding

by its characteristics, but without application of wax occlusal rims (formed by

maximum

lossing two lateral or four frontal teeth).

II -includes tooth rows with remained teeth antagonists (height of bite may be stabil
or instabil) but they are located in such a way (only in two points (anterior and lateral
parts or only in lateral sides on the right or left) that it is impossible to put models in
position of centric occlusion without wax occlusal rims.
III-includes the jaws with teeth, but they are located in such a way, that there is no
pair of teeth antagonists (not fixed height of bite).
Determination and fixation of centric occlusion in prosthetic treatment of PA with
fixed partial denture.

In mandibular-cranian reports it is necessary to distinguish two fundamental

corelations:

I – position of centric occlusion

II – centric relationship

„Occlusio” from latin – to contact, to close.

Occlusionis a static contact relationship between upper and lower dental arches
not depending on mandibulocranian report. It is a position of the lower jaw at
which this or that number of lower teeth are in close contact with upper teeth.

At the same time with this situation during movements of the lower jaw provided
by mastication muscles will be created various mandibular-cranian reports at
which lower dental arch will contact with upper realizing occlusion – this
interdentally contact is appreciated as dynamic occlusion.

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The 3 GOLDEN RULES OF OCCLUSION

1. bilateral and even occlusal contact.

2.posterior teeth disoclusion, or anterior and canine guidance. Anterior and canine
guidance allows for the immediate disclusion of molars and premolars when
making lateral or protrusive movements, such as in chewing.

3. unobstructed envelope of function.14 During the chewing motion, the mandible

does not only swing laterally, it swings forward (protrusively) during the
closure movement, returning back into the centric stop. This is called the
envelope of function.

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*************

Going from these two conception the modern concept determines occlusion as
static or dynamic contact between dental arches irrespective from
relationships between them.

That is are distingushed static and dynamic occlusion.

Static occlusion - contacts of teeth in usual compressed jaws'position.

Character of teeth contact in centric occlusion position is called bite.

Dynamic occlusion - the interaction between the teeth when moving jaw.

From practic point of view can be determined 5 basic kinds of static occlusion:

Centric– that in the vertical and horizontal position of the mandible in which the
cusps of the mandibular and maxillary teeth interdigitate maximally;

Protrusive - (anteroclusion or forward);

- Retrusive - distoclusion;

- Lateral (right and left) – occlusion of the teeth when the lower jaw is moved to
the right or left of centric occlusion.

The centric jaws relation – is such mandible-cranian report when the lower jaw is
installed to the maxilla in such a way that the articular condyles occupy in
articular fossaes unforced retrusion position in relation to the base of the slope
of articular eminence, indifferent from the presence or absence of teeth in the
oral cavity.

This mandibular-cranian report being equilibrated by all components of

stomatognat system in

three planes (sagytal, transversal and vertical) create intermaxillae report that
provide optim vertical dimention of the lower level of the face named
physiological dimention. From this position begin and in this position finish
all movements of the mandible at realization of the main functions of
stomatognat system.

Position of centric occlusion is a position of multiple interdental contacts

between dental arches that rarely coincides with maximal intercuspidation.

For centric occlusion at orthognatic kind of bite are characteristic several signs:
dental;

- articular;

- muscular;

- faryngo – glandular.

Normal occlusion - the contact of the upper and lower teeth in the centric
relationship.

Concepts of an Ideal Occlusion

1. Condylar position – centric relation.

2. Tooth position – maximum intercuspation.

3. Lateral movements are canine-guided.

4. Axial loading of occlusal forces.

5. In MI, posterior teeth contacts dominate.

In rest pozition, due to equilibrated muscle relaxation, gravitation the mandible

is displaced down stoped at some distance from the maxila. This muscles
relaxation is relative because muscles keep their functional tonicity necessary
for keeping the mandible in this position. This fenomena of mandibular
positioning is appreciated as NEUTRAL POSITION OF MANDIBLE – is a
position of equilibrium between the muscles elevating the mandible and the
muscles depressor mandible, that can be evidentiate at the level of dental
arches with the presence of space between them equal from 1 till 6 mm
(aproximatelly 2-3 mm).

The rest jaw relation - is the relationship of the mandible to the maxilla when
the person is seated at ease in an upright position with the Frankfort
plane horisontal and the muscles controlling the mandible in equilibrium.

The rest jaw relation depends on:

- a balance of muscular forces between the muscles attached to the mandible;

- emotion;

- physical health;

- age;

- proprioception from the teeth, muscles and oral mucosa;

- lossing tooth.

According to modern concept REST MANDIBLE POSITION

is realised by active and passive elements of stomatognat system:

a) active:

- stomatognat system muscle’s tonicity;

b) passive:

- specific action of muscle-tendon complex;

- TMJs;

- negative pressure from oral cavity that appear at mandible and tongue moving
down, but cheeks keep contact between them.

The relative physiological rest of the lower jaw by V.Burlui

is “... the sum of correlationships between the mandible and the cranium when the
mandible is situated in distal (back) position to the cranium being under effect of
tonic equilibrium of mastication muscles anti-gravitational”

Height of occlusion (Vertical dimension of occlusion)

or VDO, also known as occlusal vertical dimension (OVD) is a term used in

dentistry to indicate the superior-inferior relationship of the maxilla and
the mandible when the teeth are situated in maximum intercuspation.

A VDO is not only possessed by people who have teeth,however;for

completely edentulous individuals who do not have any teeth with which to
 position themselves in maximum intercuspation, VDO can be measured based
on subjective signs related to esthetics and phonetics.

Maximal intercuspal position -is the relation of opposing occlusal surfaces at

which the cusps of the maxillary and mandibular teeth contact with maximum
intercuspation.

It is dependent upon the presence of tooth contact (natural or artificial) in the

molar and (or) premolar regions of both jaws.

In many dentulous subjects, centric jaw relation and the maximal intercuspal
position do not correspond, but in the treatment of edentulous subjects they
must correspond.

The occlusal vertical dimension refers to the distance measured between two
points when the occluding members are in contact, and the rest vertical
dimension is defined as the distance between two selected points measured
when the mandible is in the rest physiologic position.

Methods of Recording Jaw relations:

1) Direct Apposition of Casts.

2) Use of Record blocks attached to the Framework.

In case of stabile occlusion (Ene, 1981) can be present two clinical aspects:

a) Patients with partial edentation with stabile occlusal stops in maximal

intecuspidation whose interjaws and occlusal relationships do not change after
teeth preparation under microartificial prosthesis (bridge denture).

b) Patients with partial edentation with stabile occlusal stops in maximal

intecuspidation whose interjaws and occlusal relation will change after
teeth preparation under microartificial prosthesis (because during
teeth preparation occlusal stops will be distroyed).
Methods of fixing central occlusion or central jaws relations in case of stabile
occlusion

At the patients with stable occlusion (the situation а) by Еnе) the centric
occlusion will not be registrated and working models in the laboratory will be
fixed without any materials, according to dental signs.

But, when distal teeth will be prepared (the situation б) by Еnе) it will be
necessary to register interjaws relationships. With this purpose the various
materials will be used: wax, thermoplastic impression materials, elastic
impression materials etc. having arranged a part of one of materials on
occlusal surface of prepared teeth and, then having closed jaws in a maximal
inter-dental contacts. After hardening material this small impression is
removed from the oral cavity and transported to the laboratory.

Methods of fixing central occlusion or central jaws relationships in case of

instable occlusion

At nonstable occlusion to compare working models in central occlusion it is

possible with the help of :

а) gypsum or from double impression material blocks (when on dental arches are
present not less than 2 - 3 pairs of teeth antagonists with the not changed
contacts and height of occlusion), thermoplastic or silicone impression
materials;

б) wax occlusal rims (at instable occlusion, when there is even one pair of teeth
antagonists and there is no fixed height of occlusion). At presence even one
dental-dental contact height of occlusion will not be defined (determined), but
the neutral position of the lower jaw will be defined (determined).

Consequity of determination and fixation interjaws relationships in case of

absence of occlusion

adapting the occlusal rims. First on the upper jaw:

a) vestibular curve of the occlusal rim;

b) plane of occlusion (sagital – Spee curve, transversal – Monson-Wilson curve.

And then – on the lower jaw – according to the upper one;

determination of vertical dimension (anatomical, antropometrical,

anatomofisiological methods);

determination of neutral position of the mandible and central jaws relation

(using different methods:

a) maximal opening of the mouth and fast its closing;

b) manual placing of the mandible;

c) placing the doctor’s fingers on the occlusal surface of the occlusal rims in their
distal zones, etc.

- and fixation of neutral position of the mandible and central jaws

relationships (with the help of wire clams, wax, etc.).
Limited partial edentation. Indications and contra-indications to treatment of
partial edentation with Fixed Partial Dentures. Principles of choosing and
inclusion of support teeth in Fixed Partial Dentures. Soldering Bridge Dentures.
Support teeth preparation. Getting impressions.

Variety of tooth artificial denture used at treatment of partial edentation

- partial fixed denture

- partial removable acrilic denture

- partial removable elastic denture

- skeletized removable denture

- prosthetic treatment on implants.

The choice of construction depends on:

a) topography and extention of dental arch defect

b) condition of hard tissues and periodontium of remained teeth

c) functional correlationships of antagonists group of the teeth;

d) type of bite

e) interjaws relationship

f) functional condition of the mucosa of toothless parts of alveolar process

f) general body condition

g) pacients profession

h) equipments and materials conditions etc.

j) form and sizes of toothless part of alveolar process

The Fixed Partial Denture

is a prosthetic appliance that is permanently attached to remaining teeth or

implants and replaces one or more missing teeth.

A tooth or implant serving as an attachment for a fixed partial denture is called an

abutment.

Advantages:

Advantages:

- restoration of integrity of dental arch

- restoration the main function of stomatognat system (mastication function,

phonetic function)

- distribution the forces of bite properly by replacing missing teeth

- prevent remaining teeth from drifting out of position

- help to preserve the natural function and position of the teeth

 - restore and maintain natural bite

- restoration the esthetic (shape of the face, smile)

- prevention of TMJ, muscles disorders

- prevention of general disorders.

Disadvantages:

- necessity of teeth preparation under support elements and creating

paralelism between them

- possibility of damaging soft tissues under the body of the bridge denture

- possibility of appearing of allergic reaction to the used material

- possibility of functional overloading teeth parodontium in the case of wrong

choice of construction

- irritating influence of artificial crown on the marginal parodontium

- unsatisfied aesthetic qualities

- difficulties in hygienic nursing of bridge denture because of fixed

construction.

Using Bridge Dentures in case of prosthetic treatment of patients with partial

adentia

and choosing denture construction are defined by the following factors:

1. the size and topography of the tooth row defect (terminal or intercalate
defect);

2. condition of hard tooth tissues and periodontium of support teeth and their
antagonists;

3. profession, age and body condition of the patient;

4. occlusal relationships.
Indications to prosthetic treatment of partial adentia with BRIDGE DENTURE:

1) loosing from 1 till 3 neighboring teeth, in some cases loss of one or four
incisors

2) loss of canine

3) loss of one or more premolars

4) loss of two premolars and the first molar

5) permissible loss of two premolars on one side of the jaw, the first and the second
molars with preserved and well-developed third molar.

Contraindications to BD using:

Local:

Relative:

- young patient (till 18 – 23);

- inflamation process in apical tooth area;

- inflamation or pathological process in mucosa of the oral cavity etc.

Absolute:

- absence of more then 3 neighboring teeth;

- III degree of pathological tooth mobility of suăpport teeth;

- untreated or impossible to treat inflamation process in apical tooth area;

General:

Relative:

- cardiac accident;

- infection deseases;

- some mental deseases in acute form etc.

Absolute:

- some mental disorders;

- allergic reaction to used material etc.

Classification of artificial Bridge Denture:

according to different signs:

- material used for their manufacturing (metal, plastic, ceramic or porcelain and
combined (M/A, M/C);

- the character of fixation (fixed and removable);

- method of their manufacturing (soldering, cast);

- construction (integral or solid, compound);

- relation of the bridge pontic to alveolar process pointed и hygienic;

- position of the support teeth (two sided and one sided support – console);

- construction of the support part of the bridge denture (different kinds of

artificial crowns, semi crowns, lays, substitution teeth and their combinations);

- the construction of the pontic (metal, plastic, ceramic and combined);

- the number of support teeth (on one support tooth – console bridge denture, on
two support teeth, on the tree and more support teeth);

- correlation of the body of the BD with alveolar process (saddle, semi-saddle,

tangential, with point contact).

Soldering Bridge Dentures consists from stamp artificial crowns and cast pontic
soldered together.

Clinical-laboratory stages of soldering bridge denture

CLINICAL – patient’s examination, dyagnosis, choosing a method of treatment,

making an anaesthesia, support teeth preparation, taking impressions, determining
and registrating CO, protection of prepared teeth by covering them with protective
lacquer or temporal crowns;

LABORATORY – making a patterns (or a ghypsum models) and their fixing in

an simulator. Modeling swage crowns (on a pattern wax reproduction of future
teeth crowns, gypsum die making, mold making, making metal die (two) from low
temperature melted metal alloys, choosing prefab unit (cap) and their fitting,
primary and final stamping, processing the crowns and their testing on the gypsum
mold.

CLINICAL – testing the crowns in the oral cavity, taking impression from the
tooth arch with swage crowns put on the support teeth.

LABORATORY – making a model with swage crowns on it, modeling pontic,

casting, soldering pontic of future BD to tested swage crowns, testing the BD on
the model.

CLINICAL – testing BD in the oral cavity;

LABORATORY – final processing, polishing and finishing soldering BD.

CLINICAL – final testing and fixing of soldering BD in the oral cavity.

Prosthetic treatment of partial edentation with Full Cast Dental Bridge.

Indications to cast bridge denture manufacturing. Support teeth preparation.
Taking impressions.

Cast bridge denture is the bridge made from metal alloy.

Advantages:

- absence of solder

- higher durability

- exact modelling

- effective in functional relation

- uniform and close touching artificial crowns to the surface of abutment

- well fixed on support teeth

- safety feet occlusal relations etc.

Disadvantages of metal DB:

- can not be used in every clinical situations

- not esthetic

Indications to prosthetic treatment of partial edentation with cast bridge denture

- all clinical situations when in the lateral areas of dental arches there are
clinical-technical conditions for creating parallelism between support teeth,
fixation and stabilisation of construction.

Contraindications to prosthetic treatment of partial edentation with cast bridge

denture:

a) Local b) General

Relative:

- young patient (till 18 – 23);

- inflamation process in apical tooth area;

- inflamation or pathological process in mucosa of the oral cavity;

- small and low crowns of support teeth if it is not possible to change it;

Absolute:

- absence of more then 3 neighboring teeth;

- III degree of pathological tooth mobility of suăpport teeth;

- untreated or impossible to treat inflamation process in apical tooth area;

- allergic reaction to used material.

Clinical- laboratory stages of making solid-cast bridge prostheses includes:

1. Examination of the patient, diagnosis, plan of treatment, anestezia, preparation
of support teeth with preliminary retraction, getting impressions, CO and VD
determination and fixation (depending on clinical case).

2. Gypsum models making, their fixing in simulator, construction the wax

reproduction of FCBD component (wax pattern). Casting. Testing BD on the
model.

3. Testing BD on the model. Testing BD in the oral cavity.

4. Final preparation BD.

5. Final testing and fixing FCBD in the oral cavity. Advises.

Peculiarities of support teeth preparation in the cervical tooth area:

1) with bevel

2) without bevel

3) mix

Possible complications in cast BD manufacturing can be divided:

a) complications appearing during the preparation itself

b) complications appearing straight away after tooth preparation

c) complications appearing some time later after tooth preparation.

Limited partial edentation. Indications and stages of prosthetic treatment

with non-metal bridge dentures.

The non-metal plastic bridge dentures are made during one laboratory stage, but
their main disadvantage is low durability. They have negative influence on tissues
of the oral cavity, can have allergic properties, therefore they are indicated at small
(1-2 teeth) defects of dental arch in frontal area.
Composite artificial bridge dentures are stronger, than plastic, indifferent to soft
tissues and more aesthetic because of possibility to create colour of natural teeth.
Indications are the same as for plastic artificial bridge dentures. The process of
polymerization depends on the kind of composite.

Porcelain artificial bridge dentures acquire parallelism of support teeth, their

sufficient height and small incisor overlapping. Preparation of teeth will be carried
out as under porcelain crowns with creation of parallelism between them.
Laboratory stages are the same as at manufacturing porcelain crowns (made by
classical or modern method).

Disadvantages of non-metal bridge dentures:

- can not be used in every type of partial adentia (especially ceramic BD);

- necessity of deeper preparation of hard tooth tissues of support teeth;

- necessary presence of support teeth with high crowns and creation of strict
parallelism between them;

- possible broken of bridge, especially acryic one that make to use them as
temporal construction;

- plastic - hygroscopic material, causing in actively absorbtion of water and

have properties of swelling;

- plastic rapidly changes in color, absorbing pigments;

- acrylic bridge lead to marginal periodontium tissues irritation;

- possible changes of colour of plastic;

- ceramic bridge can lead to pathological abrasion of teeth antagonists etc.

Indications to nonmetal Bridge Dentures manufacturing:

1. Partial adentia with absence of 1-2 neigboring situated teeth in frontal area
of dental arch.
 2. Plastic BD is used as temporal Bridge Denture.

3. Presence of high and big in volume support teeth.

Contraindications to non-metal Bridge Dentures manufacturing:

1. Absence of more then 1-2 neigboring situated teeth.

2. Partial adentia in lateral area of dental arch, if the acrylic BD is not used as
temporal prosthesis.

3. Small in volume and short in high natural crowns of support teeth.

4. Deep kind of occlusion.

5. Bruxism.

6. Allergy to plastic or composite material.

7. Not treated or impossible to treat apical tooth area pathological processes.

8. Childhood and adolescence.

Clinical-laboratory steps of Ceramic Bridge Denture manufacturing:

CLINICAL – patient’s examination, dyagnosis, choosing method of treatment,

making an anaesthesia (if it is necessary), hard tooth tissues preparation, taking the
impressions, determining and registrating interjaws relationships, determination the
colour of ceramic, protection of remained hard tooth tissues by covering them with
protective lacquer or temporal crowns (an important aspect of restoring damaged
teeth).

LABORATORY – making ghypsum models and their fixing in simulator. Making

bridge denture by burning layers of ceramic and his testing on the gypsum mold.

CLINICAL – testing Bride Denture in the oral cavity.

LABORATORY – correction and glasing BD, testing the BD on the model.

CLINICAL – final testing and fixing the BD in the oral cavity. Advises.
Clinical-laboratory steps of Acrylic Bridge Denture manufacturing:

CLINICAL – patient’s examination, dyagnosis, choosing method of treatment,

making an anaesthesia (if it is necessary), hard tooth tissues preparation, taking the
impressions, determining and registrating interjaws relationships, determination the
colour of acryl, protection of remained hard tooth tissues by covering them with
protective lacquer or temporal crowns (an important aspect of restoring damaged
teeth).

LABORATORY – making ghypsum models and their fixing in an articulator.

Modelling BD from the wax and changing the wax in acryl by polimerisation and
his testing on the gypsum mold.

CLINICAL – testing Bride Denture in the oral cavity.

LABORATORY – correction and polishing BD, testing the BD on the model.

CLINICAL – final testing and fixing the BD in the oral cavity. Advises.

Clinical-laboratory steps of Composite Bridge Denture manufacturing:

CLINICAL – patient’s examination, dyagnosis, choosing method of treatment,

making an anaesthesia (if it is necessary), hard tooth tissues preparation, taking the
impressions, determining and registrating interjaws relationships, determination the
colour of composite, protection of remained hard tooth tissues by covering them
with protective lacquer or temporal crowns (an important aspect of restoring
damaged teeth).

LABORATORY – making ghypsum models and their fixing in an articulator.

Modelling BD from the composite by fotopolimerisation and his testing on the
gypsum mold.

CLINICAL – testing Bride Denture in the oral cavity.

LABORATORY – correction and polishing BD, testing the BD on the model.

CLINICAL – final testing and fixing the BD in the oral cavity.

Errors at BD using:

1) result of incomplete examination of the patient is wrong determination of

clinical status of support teeth;

2) expansion of indications to using bridge dentures takes place when it is not

taken into account pathogenesis of disease or the nature of relationships between
bridge dentures and tissues of prosthetic field;

3) overloading support teeth and their premature removing - due to incorrect

selection of number of support teeth because of incorrect determination of their
capabilities;

4) inadequate previous special training, which did not eliminate disorders of

occlusion;

5) injurying mucous membrane of alveolar process (in case of errors in modelling

pontic of BD, which was created with large contact area with mucousa);

6) absence of multiple occlusal contacts of BD with teeth antagonists;

7) incorrect modeling cusps of artificial teeth;

8) icreasing interalveolar height on dental bridge;

9) poor aesthetic quality of bridges;

10) different technical errors.

Limited partial edentation. Indications and stages of prosthetic treatment with

M/A bridge dentures.

Variants of combined MetalAcryl Bridge Dentures:

A) Depending on type of made metal frame:

1.On the base of swage crowns.

2.On the base of cast crowns.

B) Depending on physiognomical properties:

1.Total physiognomical.

2.Half or semiphysiognomical.

Indications to prosthetic treatment of partial edentation with Metal-Acryl Bridge

Dentures on the base of swage crowns:

1) lossing from 1 till 3 neighboring teeth in frontal or lateral area;

2) loss of one or two premolars;

4) loss of two premolars and the first molar;

5) permissible loss of two premolars on one side of the jaw, the first and the second
molars with preserved and well-developed third molar.

Contraindications to prosthetic treatment of partial edentation with metal-acryl

bridge dentures on the base of swage crowns:

Local:

Relative:

- young patient (till 18 – 23);

- inflamation process in apical tooth area;

- inflamation or pathological process in mucosa of the oral cavity etc.

Absolute:

- absence of more then 3 neighboring teeth;

- III degree of pathological tooth mobility of suăpport teeth;

- untreated or impossible to treat inflamation process in apical tooth area;

General:

Relative:

- cardiac accident;
 - infection deseases;

- some mental deseases in acute form etc.

Absolute:

- some mental disorders;

- allergic reaction to used material etc.

Stages of combined M/A Bridge Dentures on the base of swage crowns

manufacturing:

CL – patient’s examination, dyagnosis, choosing method of treatment, anaesthesia

making, support teeth preparation (depending on chosed method), taking
impressions, determining and registrating CR and VD, protection of prepared
teeth;

LAB – making a patterns, their fixing in simulator, modeling swage crowns and
their testing on gypsum mold.

CL – testing crowns in the oral cavity, taking impression from the dental arch with
swage crowns put on the support teeth;

LAB – making a model with swage crowns on it, modeling pontic, casting,
soldering pontic of future BD to tested swage crowns, testing the BD on the model.

CL – testing BD in the oral cavity, processing depending on used method,

determination of acryl colour;

LAB – final processing, polishing and finishing soldering BD.

CL – final testing and fixing of soldering BD in the oral cavity.

Metal-acrylic Bridge Denture on the base of cast crowns is cast bridge, which,
along with high accuracy can achieve a good cosmetic effect, thanks to Plastic
covering all parts of prosthesis' wall.

Clinical-laboratory stages of M/A on the base of cast crowns BD manufacturing:

Cl - examination of the patient, diagnosis, treatment plan, retraction of the gums,
getting impressions, determination and fixation of centric occlusion and vertical
dimension, making and fixing temporal bridge denture;

Lab – manufacturing working and auxiliary models and their fixing in simulator,
modeling framework from wax, retention pearls glued to the framework, changing
wax on metal, polishung and grinding metal bridge framework;

Cl – verification the design of the metal frame, determination the color of plastic
liner;

Lab – wax part modeling, changing wax on plastic by polimerisation, polishing;

Cl – testing and fixing BD, recommandations.

Limited partial edentation. Indications and stages of prosthetic treatment

with metal-fused ceramic Bridge Dentures.

Porcelain, as covering material, can be used not only in manufacturing single

artificial dental crowns, and dental bridges. A ceramic material may be defined as
any inorganic crystalline oxide material. It is solid and inert.

Special attention in planning of metal fused ceramic BD should be given to

indications for their using.

Must be taken into considerations the following facts:

1) possibility of covering abutments with metal fused ceramic crowns

2) determination the possibilities of manufacturing metal fused ceramic bridge

denture pontic

3) according to considerations of some authors such BD are indicated at the

absence of 2-3 neighboring teeth, (using noble metal alloys), and at 2-4
neighboring teeth (using stainless steel alloy).

Contraindications to metal fused ceramic BD using include:

Local:
Relative:

- young patient (till 18 – 23);

- inflamation process in apical tooth area;

- inflamation or pathological process in mucosa of the oral cavity etc.

Absolute:

- large defects of dentition (3-4 neighboring teeth and more);

- III degree of pathological tooth mobility of support teeth;

- untreated or impossible to treat inflamation process in apical tooth area;

- defects, limited with supporting teeth with low clinical crowns, when
support teeth preparation will result in significant shortening of abutment
teeth and bad fixation of bridge denture;

- at compensated form of pathological teeth abrasion when support teeth

preparation it is also difficult, or, contrary, at uncompensated forms of
pathological abrasion when interocclusal space at rest mandible position is
more than 5 mm –in this case the layer of ceramic is too large and can broke
with time;

- patients with parafunctions of mastications muscles - because of possibility

of porcelain cracking due to excessive contraction of masticatory muscles;

- deep kind of occlusion;

General:

Relative:

- cardiac accident;

- infection deseases;

Absolute:
 - some mental deseases in acute form etc.

- patients with unstable mentality, awaiting from doctor unusual effects or

distorted even with quite successful results of the treatment.

Variants of combined metal fused ceramic BD

A) Depending on physiognomical properties: 1.Total physiognomical;

2.Half or semiphysiognomical.

B) Depending on used metal alloy:

1. On nonnoble metal alloy;

2. On half-noble metal alloy;

3. On noble metal alloy.

Clinical-laboratory stages of M/C BD manufacturing:

Cl - examination of the patient, diagnosis, treatment plan, support teeth

preparation, retraction of the gums, getting impressions, determination and fixation
of centric occlusion and vertical dimension, making and fixing temporal bridge
denture;

Lab – manufacturing working and auxiliary models and their fixing in simulator,
modeling framework from wax, changing wax on metal, testing metal part of BD
on model;

Cl – verification the design of the metal frame, determination the color of ceramic
lyner;

Lab – ceramic layering;

Cl – testing BD in the oral cavity;

Lab – glasing;

Cl – testing and fixing BD, recommandations.

Possible errors at M/C B D manufacturing:

1) incomplete examination of patient with wrong determination of clinical

status of support teeth and as a result - functional overloading;

2) inadequate previous special training, which did not eliminate disorders of

occlusion;

3) injurying mucous membrane of alveolar process (in case of errors in

modelling pontic of BD, which was created with large contact area with
mucousa);

4) absence of multiple occlusal contacts of BD with teeth antagonists;

5) incorrect modeling cusps of artificial teeth;

6) icreasing interalveolar height on dental bridge;

7) poor aesthetic quality of bridges because of incorect modeled shape of BD

etc.

Limited partial edentation. Indications and stages of prosthetic treatment

with removable bridge denture and bridge denture fixed on implants.

Advantages of Bridge Dentures fixed on implants:

- uniform distribution of mastication pressue on implants;

- bone tissue of alveolar processes is protected from atrophy;

- is not necessary to prepare neighboring teeth or to make removable dentures;

- long period of wearing in case of correct carrying;

- long service life: at least 15-20 years (in two times more then BD on natural
teeth) with gentle care for dentures and implants;

- reliable fixation, closely fit to the gums;

 - uniform distribution of mastication pressure on bone;

- simple care for dentures.

Disadvantages of Bridge Dentures fixed on implants:

- can not be used in every clinical situations;

- price;

- not in every cases satisfied aesthetics;

- dificulties in hygienic wearing etc.

An implant-supported bridge consists of:

- the implant - made from titanium and surgically placed in the jawbone (for
each missing tooth, in another cases, may be left one or more spaces,
occupayed in the past by natural teeth, because of not enough jawbone, or
because of too close space to a nerve or sinus cavity;

- the abutment - a cylinder made from titanium, gold or porcelain, screwed

onto the implant. In the past, some abutments were attached to the implant
using cement. Today all abutments are secured with screws. Abutments can
be pre-fabricated or custom-made by the dental lab;

- the restoration (the part that looks like teeth) is a series of crowns
connected to form a bridge. They are made of porcelain attached and fused
to a substructure of metal.

Indications:

- absence of several teeth in a dental arch

- therminal defect of dental arch;

- if the implants will be placed next to natural teeth, the natural teeth and
surrounding gums must be in good health.

Types of Dental Bridges on implants:

- plastic bridges on implants: the most inexpensive, used as a temporary
option (for up to 3-5 years), because not enough aesthetic and have a short
life time. Mostly they are used for the patient adaptation to new teeth, and in
cases when it is necessary to wear lightweight construction, if it is not
possible immediately installation of BD on metal or zirconium;

- metal-ceramic bridges on implants: the best in cost and quality. This

prosthesis is very reliable because of including a metal base in crowns, that
is connected with a metal implant, realised very strong and durable
connection. And ceramic layering crown gives to prosthesis excellent
appearance;

- oxide-zirconium and oxide-alumminium dental bridges on implants permit

to realise dental bridges on 4 or more crowns, and beying fixed on implants
creat so durable construction that can stay at least 20 years. In addition,
dental bridges on oxide-zirconium possess incredible aesthetics - to
distinguish natural tooth from artificial tooth is almost impossible!