Fixed Dental Prostheses: Bridge

Prior to Appointment:

1. Take alginate impression of mouth

2. Create putty stent (or plastic if you have extra copies of the cast)

3. Drill ideal prep: (or slightly larger than ideal because will "reline" temp)

   1. • Occlusal clearance=1.5(lingual)-2.0 (buccal)mm

      • Lingual Chamfer: metal collars=0.3-0.7mm

        • 0.5-1.0 lingual overall axial reduction

      • Buccal Shoulder: porcelain=1.0-1.2 mm

        • 1.5mm facial overall axial reduction

      • Anterior: Lingual clearance: 1-1.5mm, 2mm incisal reduction

      • Gingival Extensions: 0.2-0.5mm above gingiva

      • Proximal clearance: 0.5mm minimum

      • 6-10 degree taper, 3mm long axial walls

4. Create temp with bisacrylic or jet acrylic

Appointment:

Removal of the Crown:

1. Local Anesthesia

2. If PFM, make a slot in the porcelain to the metal with 846 diamond bur above the buccal margin

3. Continue up the buccal surface to the occlusal, barely cutting through to the cement.

4. Continue from the occlusal surface onto the lingual surface until 1-2 mm of uncut crown remains near the lingual margin

5. Use a T-bar, a strong spoon excavator or other instrument and place it in the groove and gently separate the two parts of the crown.

6. Remove the crown w/ GC Haus backpliers

Preparation:

1. If previous crown, use carbide burs and T-bar to remove the crown

2. 877 bur for lingual chamfer (0.3-0.7mm)

   1. Line up bur in Line of Draw and move to second tooth without changing angle

3. 850 bur for interproximal break

4. Use 856 bur on the buccal for shoulder (1-1.2mm)

5. Remove any lips on the margin

6. Make sure all preps have the same line of draw

   1. Can inject Quickset plaster cast (or Mach-2 Silicone) of quadrant alginate impression and set on surveyor

7. Bite Registration for Cast Mounting:

   1. Use Filled Polyvinylsiloxane and inject into ONLY the preps, you want just the cusp tips

   2. Trim excess

8. Take provisional restoration made prior to appointment, and reline by adding tempbond

9. Take impression using double bite impression, submit it with bite registration

10. IF LAST TOOTH IN THE MOUTH:

    1. Take full mouth impression

    2. Send it to the lab for pour up

    3. They will send it back to you, you will mount it with the cast mounting (PVS)

    4. You will send the casts to the lab for final restoration