bridge failure
TRANSCRIPT
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Bridge Failure
Dr. Aneeqa YaqubDr. Moazam Ali
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Manifestations of failure
Pain Inability to function Dissatisfaction with esthetics Broken teeth and/or restoration Inflammatory swelling Bad taste Bad breath Bleeding gums Anxiety
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Causes of fixed prosthesis failure
Improper case selection Faulty diagnosis and treatment plan Inaccurate clinical or laboratory procedures Poor patient care and maintenance
following insertion
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Classification of fixed prosthesis failure
• Discomfort• Caries• Pulp injury• Periodontal
breakdown• Occlusal
problems• Tooth
perforation• Tooth fracture
Biological
Mechanical
• Looseness or dislodgement
• Prosthesis fracture
• Occlusal wear or perforation
Esthetic
• At the time of cementation
• Delayed esthetic failure
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Biological failures
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Biological Failures
Periodontal breakdown
Caries
• Inadequate abutment teeth
• Periodontally affected abutment teeth
• Poor oral hygiene• Improperly constructed
prosthesis
• Methods of detection
• Detection • Management
Occlusal problems
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Periodontal breakdown
Caries
Occlusal problems
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Biological Failures
Discomfort
Tooth perforation
• Pressure on soft tissue• Traumatic occlusion• Torque• Cervical hypersensitivity
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Discomfort
Tooth perforation
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Biological Failures
Pulp injury
Abutment fracture
• Over heating• Over reduction• Minute pulp
exposure• Inadequate
protection• Recurrent caries
• Coronal• Root
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Abutment fracture
Pulp injury
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Mechanical failures
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Mechanical Failures
Looseness or dislodgement
Prosthesis fracture
Occlusal wear or perforation
• Lack of retentiono Faulty preparationo Improper designo Improper
construction• Recurrent caries• Mobility • Torque• Faulty cementation
• Joint fractures• Facing fractures• All ceramic crown
fractureo Faulty
preparationo Faulty
constructiono Faulty
cementation• Post fracture
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Occlusal wear
Prosthesis fracture
Looseness
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Esthetic failures
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Esthetic Failures
At the time of cementation
Delayed esthetic failures
• Actual failures o Color mismatcho Poor tooth contour,
marginal roughness & extension
o Metal display in partial coverage
o Improper pontic placemento Porcelain fracture during
cementation• Color blindness• Unrealistic complains by the
pt.o Inadequate communicationo Unrealistic expectations of
pt.o Dysmorphophobia
• Gingival recession• Sub pontic tissue
shrinkage• Periodontal surgery• Porosity• Drifting of anterior
teeth• wear
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Avoiding failures
Caution at the planning stage Confirmation of diagnosis and treatment
plan for inexperienced operator Expertise of the technician Treatment of preoperative problems Search for the primary cause of failure
rather than the apparent
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When the prognosis is questionable ???
The methods used to facilitate re-treatment are: Use of temporary cement Design of prosthesis for possible future addition The placement of a rest seat for possible future use Specified undercut or guide plane of a crown, even
when denture is not planned Planning and noting solder joint placement Recording of shades Recording of cement used Retention of working casts and provisional
restorations
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CASE Presentation
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Carious Abutments
CASE # 1•75 years old•6- units bridge•Satisfactory for 9 yrs•Prefer not to have a new one•Clinical examination: carious abutments 11, 13
Management•Caries removal•Root canal treatment•Post and core done for each tooth•Bridge lasted for the remaining 6 years
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Periodontal Breakdown
CASE # 2•Advanced periodontitis•Complicated by tooth loss and mobility•Had a partial denture (not coping well with it)•Wishes to consider a fixed restoration option•For health reasons implants were not a practical option
Management•Teeth prepared for full crowns•Telescopic crowns with parallel path of insertion cemented permanently• One piece fixed bridge fabricated over the crowns
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THANK YOU