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بس
م الله الرحمن الرحيم
:In this lecture we will talk about
Bridges configuration -
Biomechanical principles of tooth preparation -
Bridges configuration
Last lecture we ended up with bridges configuration which is a
.'separated chapter in the book 'shillingburg
It will be a quick revision for bridge configuration because the
.principles almost mentioned in the abutment evaluation lecture
This chapter is divided into simple design bridges and complex design
bridges, you are requested for simple design bridges(which means single
..tooth replacement bridges) and canine replacement bridges
Dr. said: There is few details in the book, you have to come cross them,
this details will be more clear when we get resin-bonded bridges lecture..
((I added them next
All the mentioned bridges are simple bridges by design because you
.have single missing tooth
In canine replacement bridges, it's again single tooth replacement
bridges, but I mentioned last lecture that they aren't along the
interabutment line, so we have a torque, unfavourable leverage, or
unfavourable load distribution, then conventional bridge won't work, I
..mean 2 abutments won't work
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
Biomechanical principles
of tooth preparation
We will go for further details in fixed prosthodontics, the first lecture
was definitions, second lecture was treatment planning either about
extracoronal, intracoronal or replacement bridges, third lecture was about
abutment evaluation mainly for bridges, now and in this specific time you
should be able to formulate a treatment plan for your patient, if you do
that then you are able to start fabrication of this prostheses, I assume if I
asked any body of you about replacement or restoration of any tooth in
terms of fixed prosthodontics you should be able to tell me what is your
restoration, if you all reach this stage then the next step is how to
.fabricate your prostheses
(…Midterm exam will have a lot of questions about treatment plan)
Today we are going talk about proper work, we decide the treatment
..plan and we go to the next step which is tooth preparation
Tooth preparation will be only for crown and bridges, we won't talk
about intracoronal restoration.. we will talk mainly about extracoronal
restoration, some concepts might be valid for both but you need mainly to
..focus on extracoronal restoration
:Principles of preparation
When you prepare a tooth for any reason actually, for fillings, crown or
:bridges, there are 5 main principles you need to follow them
.A. preservation of tooth structure
.B. retention and resistance
.C. structural durability
.D. marginal integrity
.E. preservation of periodontium
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
:Direction of forces►
When you consider the geometry of your preparation, you need to☼
consider the direction of forces, the best force or reaction of the cement
.is the compressive force and the worst thing is the shear force
:In the picture below notice
A. tensile force
B. shear force
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
Compressive
Oblique Force
Force
I spoke about retention and resistance and I mentioned that the geometric
configuration of your preparation is very essential, this geometry is
:affected by
Taper .1
Freedom of displacement .2
Length .3
Substitution of internal features .4
Path of insertion .5
Taper .1
.Taper is the relationship between 2 opposing surfaces☻
The opposing surfaces of tooth structure must converge/diverge☻
occlusally slightly with no undercuts to allow seating the final
.restoration
The opposing surfaces must be converge occlusally in case of
extracoronal restoration (crowns), and diverge occlusally in case of
intracoronally restorations…the reason for that is because you need no
undercut to allow seating the final restoration, which means if you have
intracoronal restoration for example amalgam, what do you do in
amalgam?? We make undercut, we bring the inverted bur and walk all
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
around the walls, but we don't have problems with these undercuts
.because we can condense plastic restorations
In fixed prosthodontics it's vice versa, I need it without undercuts and
flare upward, because when we bring the inlay or onlay, this shape will
.allow us to seat them without problems
So we need it diverge occlusally in intracoronal restoration and converge
.occlusally in extracoronal restoration
The relationship between the 2 opposing walls mesial and distal, ☻
buccal and lingual is called taper.. and the relationship between the long
.axis of the tooth and one of these single walls is called inclination
The more the parallel the opposing surfaces, the better the stability of ☻
.the restoration. More forgiving in big teeth
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
your restoration. If you achieve something above it this is fine but try to
…achieve any thing under it, so 16° is your target but the ideal is 6°
TAPERNESS
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INCLINATION document or the summary of
3° 3°
an interesting point. You can
position the text box anywhere
6° in the document. Use the Text
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formatting of the pull quote
[.text box
Freedom of displacement .2
Best retention and resistance is achieved with a single path of☻
.withdrawal
The addition of auxiliary features (grooves and boxes.. ) will limit☻
.the paths of withdrawal to one
.The greater the surface areas, the better the stability☻
If you look at diagram A in the lower picture, the restoration can be☼►
placed and displaced along all of these arrows, if you start adding feature
like a grooves and boxes it will limit the number of paths of insertion and
removal, and we will end up with one path of insertion(diagram B).
☼ Imagine you have a crown and on the fitting surface of it we have
something protruding outward, they won't get into the preparation unless
.. you orient it well and seat it
All auxiliary features (grooves, boxes, pin holes..) help you to☼
minimize the number of paths of insertion and removal, if you have less
number of paths of withdrawal this mean automatically that you have less
.chance of displacement
This is how you create more retention and more resistance by☼
modification of your preparation rather than depending on the cement
.itself
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
Last time we said that in bridges we need buccal and lingual grooves☼►
.because the movement is mesiodistal
Imagine you prepare these grooves on this premolar(in the lower☼
picture), the only force which will let the grooves to resist movement is
buccal or lingual forces, so this is shear forces, which is the worst and to
minimize its effect we need to adjust our preparation and geometry, one
.of these adjustments is to create a grooves
Notice that in the previous picture the grooves help us to minimize☼
the number of paths of withdrawal and in this picture they help us to
.resist the shear forces
When you design your geometry, you consider where are shear☼
forces and compressive forces then you adjust your preparation to let the
.shear forces to be minimal and compressive forces to be maximal
Look at diagram B, the grooves are flared, and you have three-☼
quarter crown, if you push the restoration with the direction of the arrow,
let us say buccally, the restoration will flex outward with excessive
forces, if you have definitive walls like in diagram A the force will be
perpendicular to the tooth structure then the chance of displacement is
less. In other words, as we are aiming parallel walls for extracoronal
restoration we need parallel walls for our features (grooves, boxes, pin
holes..) because you need to let the forces applied to the tooth structure
to be perpendicular rather than in oblique direction that will lead to
.displace and flex the restoration
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
Length .3
.the longer and the larger the preparation, the better the retention ☻
length/width ratio is very critical specially in posterior teeth (not ☻
less than 0.4) for resistance. which means after you prepare your tooth,
the cervicoocclusal dimension should be at least 0.4 of the mesiodistal
dimension. Example: if the width was 10mm the length must be 4mm,
this is the minimum otherwise you sacrifice the retention and the
.resistance
In anterior teeth, they are narrow teeth but the minimum length is 3mm
.(correct it in the slides), otherwise you can't restore your crown
short wide preparation should be modified by auxiliary features like☻
.grooves and boxes which will improve the stability
If you have lower molar with a length/width ratio of 0.3, this is
insufficient to retain or stabilize a crown, if you need to improve it you
have to create a grooves, which needs parallel walls to reduce the shear
.forces
Retention►
The longer the preparation the better the retention, this is goes mainly☼
with surface area, so also the wider the preparation the better the
.retension
Retention increases inversely with surface area and when un-☼
.polished
Retention is just expresses itself along the long path of insertion,☼
.then adding any surface area will enhance the retention
Any increase in the surface area(by increase length or width) will☼
result in improvement of retention, but this is not applicable for
.resistance
something called arc of rotation which represented by p1, p2, p3, if you
need to displace your restoration with the direction of the arrow, there is
something called pivot point (center of rotation) that located on the finish
line and where the rupture of the restoration occur, if you make a
perpendicular line from this point crossing the preparation, then any
area below this line won't resist displacement (non-resistance area), and
any area above it will resist displacement (resistance area). And what is
.your aim?? To increase the resistance area
Arc of rotation
Resistance area
Non-resistance area
Pivot point
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
:Path of insertion .5
.we are aiming all the time for one path of insertion ☻
to reduce the number of paths of insertion, what we did?? We did ☻
.grooves, boxes.. so you adjust your geometry
.it is usually along the long axis of the tooth ☻
the stability is affected, which is resistance and retention, so if you ☻
have multiple path of insertions; the stability will be poor, and if you
.have one path of insertion; you will have a good stability
.(aesthetic and biology will be affected (explained later ☻
.in bridges, all abutments should have common path of insertion ☻
You remember in treatment plan, if you plant for a bridge you need to
create a single path of insertion for both preparation, and I mentioned
sometimes you have to sacrifice unnecessary tooth structure to create this
parallelism, if you have inclined 7 and you want to replace 6 , you need
to create a retainer on the 5 and 7 and you need to cut unnecessarily from
the mesial surface of the 7 to have common path of insertion, by this
unnecessary cut you sacrifice in retention and resistance because you are
sacrifing the taper. If you have parallel teeth from the start, then the
mesiodistal taper and buccolingual taper can be created perfectly with
16° here and 16° there to have common path of insertion. If you have a
tooth which is very tilted, so you need to cut much more from the tooth
.structure
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
C. Structural durability
occlusal reduction .1
how much you need to cut of the occlusal surface, depends on the ☻
type of the material that you will use(1-1.5mm for gold, 1.5-2mm for
metal-ceramic crown, 2mm for all-ceramic),these numbers are your
minimum preparation, and try to avoid extra cut to avoid damaging the
.tooth, also try to avoid undercut to avoid damaging the restoration
should keep the same morphology, it means for example if you ☻
prepare a molar, after you finish, you must get a smaller molar, which
means 2mm reduction is homogenous all the way through; in the fissures,
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
cusps, fossa.. so you are creating a mini molar, you can't reduce from the
cusp 2mm and leave the fissures and cut only 1mm, so you have to be
.homogenous on the occlusal surface
.inclined surfaces may not need tooth preparation ☻
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
axial reduction .3
we need to create a space, this space usually 1.2mm for metal- ☼►
ceramic crowns , 1mm for all ceramic , for gold or all-metal crowns we
talk about 0.7mm.. It’s more conservative to do metal-crown for posterior
teeth rather than to do metal-ceramic crown. But you can't do metal
.crowns anteriorly because it's not aesthetic
(Reinforcing struts(trusses .4
We can join the grooves by struts which are another simple grooves, it's
.a reinforcing design, just to enhance the structural durability
.Notice the reinforcing struts in the next picture
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C&B lec#:4 Done by: Ruba Sameer
Dr. Mousa Marashdeh Date: 11-3-09
D. marginal integrity
E. Preservation of periodontium
The End
: بالنهاية حابة اوجه تحية ل
زينببب)بببدنا, جمانببة شمسبباه,(.. جمانببة حسببن) يببا بابببا سببناني واوا,(..شهد قعببدان) غلبتببك معببي
امل, مجد الصيدلي, فاطمة الطائي, فرح عبد المعيد, نور حمدان,(.. سناء) هدافة الدفعة,(..كعكة
, ملببك, سببكينة, زينببات, شببيرين, رونببزى, فببرح القببرم, لينببا, داليا, مرام ونور الرحمون,العمري
.... ميمنة, اسيل الرفاعي, ايمان الراس, فكرية, نجلء, منى, نادية, اروى
, عمببار, اميببن محاجنببة, باسل, امين مدلج, اياس خليلية, (..عبدال عوضي)شكراً على المساعدة
...... نعيم, معاذ, محمد شعبان, محمد خزعلي,محمود
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