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The prosthesis which is cemented to the abutment and cannot be removed by the patient.
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FPDs
History
taking:
Collecting the information which are important in treatment planning and diagnosis of the disease.
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CHIEF COMPLAINT.
Chief complaint usually falls into one of the following four categories: a. Comfort( pain, sensitivity, swelling). b. Function(difficulty in mastication or speech) c. Social(bad taste or odor) d. Appearance( fractured or unattractive teeth or restorations, discoloration)
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EXAMINATION
It consists of clinical use of sight, touch, and hearing to detect conditions outside the normal range. It is critical to record what is actual observed rather than to make diagnostic comments about the condition. For example, swelling redness and bleeding on probing of gingival tissue should be recorded rather than gingival inflammation(which implies a diagnosis).
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EXAMINATION
General
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EXAMINATION
Intraoral
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EXAMINATION
Radiographic
examination. (X-ray)
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DIFFERENTIAL DIAGNOSIS
After
completion of history and examination a differential diagnosis is made. A definitive diagnosis can usually be developed after such supporting evidence has been assembled.
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PROGNOSIS
PROGNOSIS
General
Factors a. Overall caries rate. b. Diabetes c. Bite force of the patient. d. others.
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PROGNOSIS
factors: a. Vertical overlap of the anterior teeth. b. Impaction adjacent to molar that will be crowned may pose a serious threat in a younger individual in whom additional growth can be anticipated but it may be of lesser concern in an older individual.
Local
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PROGNOSIS
c. Individual tooth mobility. d. Root angulation. e. Root morphology. f. Crown-root ratio. g. Others
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DIAGNOSTIC CAST.
Material
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TRETMENT PLAINING.
IDENTIFICATION
OF THE PATIENTS NEEDS. Successful treatment planning is based on proper identification of the patients needs Ideal treatment against the patient's needs is usually a failure.
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TREATMENT PLANNING.
Correction
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MATERIALS USED
All
existing restorative materials and techniques have limitations and cannot exactly match the properties of a natural tooth structure.
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possible, FPDs should be design as simple as possible with a single well anchored retainer fixed rigidly at each end of the pontic. Teeth in which pulpal health is doubtful should be endodontic ally treated before the initiation fixed prosthodontics.
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SELECTION OF ABUTMENT
Unrestored
abutments: An unrestored caries free tooth is an ideal abutment. Mesially Tilted Second Molar: Overloading of the abutment teeth should be avoided.
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DIRECTION OF FORCES
The
occlusal forces should be directed along the long axis of the tooth. Root surface area. Antes law: Root surface area of the abutments supported by bone should be equal or more than the root surface area of the teeth which are being replaced.
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Nayman and Ericsson, however cast doubt on the validity of Antes law by demonstrating that teeth with considerably reduced bone support can be successfully used as fixed partial denture abutments.
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SEQUENCE OF TREATMENT
ORAL
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FOUNDATION RESTORATIONS
A foundation
restoration, or , core, is used to build a damaged tooth to ideal anatomic form before it is prepared for a crown.
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FOUNDATION RESTORATION
Materials used:
1. 2. 3. 4.
Dental Amalgam. Glass Ionomer. Composite Resin. Pin-retained cast metal core.
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MECANICAL CONSIDERATIONS. Affect the integrity and durability of the restoration. ESTHETIC CONSIDERATION. Affect the appearance of the patient.
3.
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BIOLOGICAL CONSIDERATIONS
1. Adjacent
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BIOLOGICAL CONSIDERATIONS
CAUSES
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BIOLOGICAL CONSIDERTION
Conservation
of Tooth Structure. Considerations Affecting Future Dental Health. 1. Axial reduction. 2. Margin Placement. 3. Margin Adaptation. 4. Margin Geometry. 5. Occlusal Consideration. 6. Preventing Tooth Fracture.
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MECHANICAL CONSIDERATIONS
Retention Form.
The quality of a preparation that prevents the restoration from becoming dislodged by such forces parallel to the path of withdrawal is known as retention.
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MECHANICAL CONSIDERATIONS.
Factors Affecting 1.
retention Form.
Magnitude of dislodging forces. 2. Geometry of the tooth preparation. 3. Roughness of the fitting surface of the restoration. 4. Material being cemented. 5. Film thickness of the luting agent.
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MECHANICAL CONSIDERATIONS
Factors
1.Magnitude
and direction of the dislodging forces. 2. Geometry of the tooth preparation. 3. Physical properties of the luting agent.
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ESTHETIC CONSIDERATIONS.
Factors 1.
Metal- Ceramic Restoration. 2. Facial Tooth Reduction. 3. Incisal Reduction. 4. Proximal Reduction. 5. Labial Margin Placement.
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Greater retention. 2. Greater resistance. 3. Superior strength. 4. Modification in tooth structure can be done.
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Extensive reduction of tooth structure. 2. Gingival inflammation. 3. Esthetics problems 4. Thermal/vitality test is difficult in complete crown.
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COMPLETE CROWNS
INDICATIONS: 1.
Extensive coronal destructive teeth( caries or trauma). 2. Where maximum retention and resistance are required. 3. Short clinical crowns. 4. Where high displacing forces are anticipated.
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COMPLETE CROWNS.
5.
Correction of axial contour of a tooth. 6. Endodontically treated teeth. 7. Congenitally malformed teeth. 8. Discolored teeth.
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COMPLETE CROWNS.
CONTRAINDICATIONS: 1.
In case where treatment objective can be achieved without crown. 2. Where light support is needed( cantilever bridge.) 3. If a high esthetic need exists as in anterior teeth.
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CROWN PREPARATION
STEPS
OF CROWN PREPARATION:
Occlusal
guiding grooves. Occlusal reduction. Axial alignment grooves. Axial reduction. Finishing and evaluation.
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posterior teeth where moderate amount of tooth structure is lost, provided the buccal wall is intact. Used as a retainer for fixed partial denture(bridge). Where alteration in the occlusal surface is needed.
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teeth that have short clinical crowns. As retainers for long span bridges. For endodontically treated teeth. In patients with active caries and periodontal diseases. In malshaped and poorly aligned teeth.
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ADVANTAGES
Conservation
of the tooth structure. Reduce the risk of pulpal and periodontal damage. Supragingival finishing lines are easily approached. Better oral hygiene can be maintained. As the margins of the restoration are usually away from the gum margins, less chances of gingivitis.
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ADVANTAGES
Cementation
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DISADVANTAGES
Less
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ceramic crowns should have even thickness circumfrentionaly. Usually about 1 to 1.5mm is needed to create an esthetically pleasing restoration. Incisally, a greater ceramic thickness may be required.
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in esthetics. Excellent translucency.(Natural look). Good tissue response. Slightly more conservative tooth reduction in preparation.
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strength due to absence of metal substructure. For shoulder preparation significant proximal tooth reduction is required. The preparation should provide support for the porcelain along its entire incisal edge. Thus a severely damage tooth should not be restored with a ceramic crown.
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DISADVANTAGES cont...
As
a retainer for FPDs, all ceramic crowns are not effective. Connectors require large cross section, as the material is brittle, this leads to gum impingement and periodontal failure.
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CONTRAINDICATIONS:
When
more conservative restoration can be used. Rarely are they indicated for molar teeth. Increased occlusal load and decreased esthetic demand.
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tooth should be assessed for the following points; 1. Apical seal. 2. Tenderness. 3. Exudate. 4. Fistula. 5. Active inflammation.
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THE AMOUNT OF REMAINING TOOTH SRUCTURE IS PROBABLY THE SINGLE MOST IMPORTANT PREDICTOR OF CLINICAL SUCCESS.
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RETENTION FORM
TEETH. Dislodgement of a retained anterior crown is frequently seen clinically and results from inadequate retention form of prepared root. Post retention is affected by: 1. Preparation Geometry. 2. Post length. 3. Diameter
ANTERIOR
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POST FABRICATION
Prefabricated
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Restoration.
It
Restore
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Types of Crowns
Clinical
Crown: It is intraoral visible tooth structure. Anatomical Crown: The area of tooth covered by enamel. Artificial Crown. a. Full veneer crown.(FVC) b. Partial veneer crown(PVC)
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Part of FPD which is used as a support and cemented to the natural tooth or implant.
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CONNECTORS: It
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PROPER
PATIENTS PATIENTS
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OF BONE LOSS.
PERIODONTALLY LONG
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PATIENTS.
COMPROMISED PATIENTS.
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CLASSIFICATION OF FPDs.
Three Each Each
major classes.
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CLASSIFICATIONS OF FPDs.
CLASS: It identify the location of the edentulous space. CLASS I: Posterior edentulous space(Molar or premolar)
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CLASSIFICATIONS OF FPDs.
CLASS
Anterior
missing)
CLASS
Antero-posterior
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CLASSIFICATIONS OF FPDs.
DIVISION: A division
teeth.
DIVISION
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CLASSIFICATIONS OF FPDs.
DIVISION
III: Pier Abutments. A single tooth is surrounded by an edentulous space on either side.
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CLASSIFICATION OF FPDs.
Sub-division:
A sub-division
Sub-division I:
Ideal
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CLASSIFICATION OF FPDs.
Sub-division II:
Tilted Abutment.(Either
Sub-division III:
Periodontally
weak abutment.
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CLSSIFICATION OF FPDs.
Sub-division IV:
Sub-division V:
Implant
abutment.
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CLASSIFICATION OF FPDs.
DEPENDING Fixed Fixed
Removable
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CLASSIFICATION OF FPDs.
DEPENDING All
ON MATERIAL USED.
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CLASSIFICATION OF FPDs
LENGTH Short Long
OF SPAN:
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CLASSIFICATION OF FPDs.
DURATION Permanent Interim
OF USE.
fixed PDs
bridges.
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OF ABUTMENTS:
Normal/
Ideal abutment. Cantilever abutment. Pier abutment. Mesially tilted. Endodontically treated abutment. Implant abutment.
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RETAINERS
Retainer
is a crown or any part of FPD that is cemented to the abutment. Major retainers( FVC,PVC.) which covers the whole occlusal surface of the abutment. Minor retainers. It a small extension that is cemented on to the tooth.
1.
2.
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TYPES OF RETAINERS.
BASED Full
ON TOOTH COVERAGE:
Partial
Conservative
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TYPES OF RETAINERS.
BASED All
metal ceramic
ceramic acrylic.
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PONTIC.
It
is an artificial tooth on a fixed partial denture that replaces a missing tooth, restores its functions and usually fills the space.
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REQUIREMENTS OF A PONTIC
1.
It should restore the functions of a tooth it replaces. 2. It should provide good aesthetics. 3. It should be comfortable to the patient. 4. It should be biocompatible. 5. It should be easy to clean. It should preserve the underlying mucosa and bone.
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PONTIC DESIGN.
FACTORS AFFECTING
THE DESIGN OF A
PONTIC.
1.Space 2. 3.
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I defects: Normal faciolingual width with normal height. II defects: Loss of ridge height with normal width. II defects: Loss in both dimensions.
CLASS
CLASS
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CLASSIFICATION OF PONTICS.
A. B. C.
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SURFACE IN CONTACT. 1.RIDGE LAP/Saddle 2. MODIFIED RIDGE LAP 3. OVATE 4. CONICAL TISSUE SURFACE NOT IN CONTACT. 1. SANITARY/Hygienic 2. MODIFIED SANITARY.
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OR RIDGE LAP: Concave fitting surface Overlap the residual ridge buccolingually.
SHOULD
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RIDGELAP PONTIC:
best features of the Hygienic and Saddle pontic designs. esthetics and easy cleaning.
Combining
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called Egg-shaped, Bullet-shaped, or Heartshaped. It only touches the residual ridge at one point. Easy to clean. Recommended in posterior teeth where esthetics is a less concern.
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PONTIC: Esthetically superior. Its convex tissue surface reside in the soft tissue depression. Socket preservation techniques are necessary for successful results.
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contact: The contact between the underlying tissues and pontic should be pressure free. Oral Hygiene Consideration: Pontic Material: It should provide good aesthetics. It should be biocompatible. It should withstand occlusal forces.
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BASED ON MATERIAL
Metal-ceramic
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pontics.
pontics
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CONNECTORS.
The portion of the Fixed Partial Dentures that unites the retainer(s) and pontic(s).
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TYPES OF CONNECTORS.
Rigid
connectors
Non-rigid
connectors.
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RIGID CONNECTORS.
Used
to unite the retainers with pontics in Fixedfixed partial dentures. connectors are used when the load is transferred directly from the pontics to the abutments.
These
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RIGID CONNECTORS
Cast
Soldered
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Non-Rigid Connectors.
Used
in situation where single path of insertion cannot be achieved due non parallel abutments. types of connectors allow limited movement between the retainer and pontics.
These
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Non-Rigid Connectors
Tenon
Mortise(female)
the retainers.
Tenon(male)
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Loop Connectors.
Used The
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Centric
occlusion: Occlusion of the opposing teeth when the mandible is in centric relation. This may or may not coincide with maximum intercuspation.
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OCCLUSION
Maximum The
intercuspation:
complete intrcuspation of the opposing teeth independent of the condyle position. occlusion:
Eccentric
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requirements of the impression material used in fixed partial dentures. Dimensional stability and accuracy Elasticity after cure. Flow. Wettability. Compatibility.
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impression material.
Primary
Secondary
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planning.
Antes
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Preparation Selection
Impression Recording
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Pouring Shade
the cast
Corresponding Demands
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Proper
Wax up.
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Intraoral
adjustment
Cementation Follow
up and maintenance.
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Tips
& Warnings
After
mixing, turn the rubber mixing bowl upside down. If the dental stone mixture does not drip to the ground, then you have the appropriate consistency. If the dental stone mixture drips to the ground, there is too much water in the mixture and more dental stone will need to be added.
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Tips of warnings.
Air
Avoid over-vibrating the dental stone mixture. Over-vibrating will create unnecessary air bubbles.
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Tips of warnings.
During
the setting time period, the stone undergoes an exothermic reaction, releasing heat. not separate the model from the impression until the model feels cold.
Do
Leave the dental stone model undisturbed for 45 to 60 minutes until the material completely sets
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After
Check
the prepared surface for bubbles and deficiencies. the prepared margins.
Outline
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SPRUES
Definition:
Its a channel through which molten alloy can reach the mold in an invested ring after the wax has been eliminated. Role of a Sprue: Create a channel to allow the molten wax to escape from the mold. Enable the molten alloy to flow into the mold which was previously occupied by the wax pattern
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SPRUES
FUNCTIONS
OF SPRUE 1 . Forms a mount for the wax pattern . 2 . Creates a channel for elimination of wax . 3 .Forms a channel for entry of molten metal 4 . Provides a reservoir of molten metal to compensate for the alloy shrinkage
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SPRUES
SELECTION
OF SPRUE 1 . DIAMETER : It should be approximately the same size of the thickest portion of the wax pattern . Too small sprue diameter suck back, results porosity. 2 . SPRUE FORMER ATTACHMENT : Sprue should be attached to the thickest portion of the wax pattern . It should be Flared for high density alloys & Restricted for low density alloys
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SPRUES
3
. SPRUE FORMER POSITION Based on the 1 .Individual judgment . 2 .Shape & form of the wax pattern . Patterns may be sprued directly or indirectly .. Indirect method is commonly used Reservoir prevents localized shrinkage porosity . Reservoir And Its Location
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Armamentarium 1.
Sprue . 2 . Sticky wax . 3 . Rubber crucible former . 4 . Casting ring . 5 . Pattern cleaner . 6 . Scalpel blade & Forceps . 7 . Bunsen burner
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SPRUES
TYPES
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WETTABILITY
To minimize the irregularities on the investment & the casting a wetting agent(SURFACTANT) can be used . FUNCTIONS OF A SURFACTANT. 1 . Reduce contact angle between liquid & wax surface . 2 .Remove any oily film left on wax pattern
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PREREQUISITES Wax
pattern should be evaluated for smoothness , finish & contour . Pattern is inspected under magnification & residual flash is removed
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CRUCIBLE It
FORMER
serves as a base for the casting ring during investing .Usually convex in shape. May be metal , plastic or rubber . Shape depends on casting machine used . Modern machines use tall crucible to enable the pattern to be positioned near the end of the casting machine .
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CASTING
RING LINERS Most common way to provide investment expansion is by using a liner in the casting ring .Traditionally asbestose was used . Non asbestose ring liner used are : 1) Aluminosilicate ceramic liner . 2) Cellulose paper liner
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Purpose
of Casting Ring Liner Ringer liner is he most commonly used technique to provide investment expansion. To ensure uniform expansion , liner is cut to fit the inside diameter of the casting ring with no overlap. Thickness of the liner should not be less than approximately 1mm. Place the liner somewhat short of the ends of the ring, 3mm, tends to produce a more uniform expansion, therefore less chance for distortion of the wax pattern & mold
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CASTING
CRUCIBLES Four types are available ; 1) Clay . 2) Carbon . 3) Quartz . 4) Zirconia Alumina
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Remove
the whole wax pattern along with the sprues very carefully.
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the wax pattern and sprues on the crucible former in such a way that the whole complex should be accommodated in the casting ring. the insulating sheet within the casting ring so that heat loss is prevented during shifting of the ring from the furnace to the casting machine.
Put
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the plaster to cool at room temperature for about 45minutes to 1hour. the casting ring in the oven for about 1hour and 30minutes and raise the temperature up to 1100 degrees cent.
Put
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Take
out the RED HOT ring from the oven and put it in the Casting machine. the red hot ring is transferred from the oven to the casting machine.
Now
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the casting is completed. it down at room temperature. the framework from the investment plaster.
Recover
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Remove Blast
Finish
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the final blasting on all the surfaces except the inner surfaces of the retainers/crowns. layer of thin mix porcelain is applied with brush on all surfaces which will be covered with porcelain. is called wash core.
A thin
This
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application of the wash core firing is done according to the specific programme. temperature of the wash core is raised up to 950 degrees instead of 930 degrees which is meant for porcelain body. firing the wash core in furnace the bridge is cool down.
The
After
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opaque layer is applied and the bridge is fired in furnace again. bridge is cool down at room temperature.
The
Apply
the body, cervical and incisal shades and put it in furnace for another required programme and raise the temperature up to 930 degrees.
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down the bridge and finish the surfaces with burs, discs, wheels.
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finishing , apply the glaze powder and put it in furnace . for three minutes, then increase the temperature up to 930 degrees in five minutes and hold at 930 degrees for 1 minute.
Preheat
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If
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Fixed prosthes es
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Retention of Restorations
Core buildup
Recreation of lost tooth structure Screwed into dentin Hold core filling material After root canal therapy Strengthens tooth
Retention pins
Fabricates restoration Makes die from impression Creates wax pattern on die Invests wax and casts invested material into metal Prepares metal for porcelain layers Finishes and polishes final restoration
Before preparation Moisten shade guide Match to natural teeth under natural light Record in patients chart Record on lab prescription
Tissue Retraction
Placed in gingival sulcus Mechanical and chemical retraction Prevents bleeding Ensures impression of gingival margin
Provisional Restorations
Temporary coverage to protect tooth between appointments Esthetics and patient comfort Stabilize contacts and occlusion Protect gingiva and interproximal areas Fit gingival margin snugly
Copyright 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 150150
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