FIXED PROSTHODONTIC

(CROWN & BRIDGE)

‫ محسه الحمزي‬/‫د‬ ‫ ) مستوى رابع طب االسنان‬7, 8( ‫محاضرة رقم‬

Componet of Bridge or Fixed Partial denture

Any bridge consist of:
1- Abutments
2- Retainers
3- Pontic.
4- Connectors.
Each part of the bridge should be designed individually, but within the context
of the overall design.

Retainers
-Retainer Definition:
It is that part of bridge or FPD, which is cemented to the abutment tooth and
holds the pontics. It may be any types of Crowns or an Inlay or Onlay.

Types of Retainers (Major or minor):

1- Full veneer crowns

A- Full metal
B- Porcelain fused to metal.
C- Full porcelain.
2- Partial veneer crowns
A- 3 / 4 crown
B- 7 / 8 crown
C- 1 / 2 crown.
D- Reverse 3 / 4 crown.
E- Pin-ledge 3 / 4 crown.
3- Resin bonded retainers
4- Intracoronal: As cast onlay and Inlay
5- Mixed.

Fixed Prosthodontics ( C & B ) 1 Dr. Mohsen Al-Hamzi

Criteria for choosing a suitable Retainer

1- Appearance
2- Condition of abutment teeth
3- Conservation of tooth
4- Alignment of abutment teeth and retention tissue
5- Occlusion
6- Oral hygienic.
7- Caries index.
8- Cost

The requirements of retainers:

- Retention
- Strength
- Esthetics.
- Biological considerations.
- Easy to prepared.

Major or minor
All fixed–fixed and cantilever bridges have only major retainers.
Fixed–movable bridges have a major retainer at one end of the pontic and a
minor retainer (carrying the movable joint) at the other.
Major retainer preparations must be retentive and, with conventional bridges,
must cover the whole occluding surface of the tooth.

A major retainer for a conventional posterior bridge should not be less than
an MOD inlay with full occlusal protection. For incisor teeth it is
usually a complete crown.
Minor retainers do not need full occlusal protection: a minor retainer may be
a complete or partial crown, or a two- or three-surface inlay
without full occlusal protection (Fig. 1). Minimum-preparation minor retainers
are also used for minimum-preparation bridges where the occlusion is
favorable.

Fixed Prosthodontics ( C & B ) 2 Dr. Mohsen Al-Hamzi

Fig. 1- Fixed–movable: a DO inlay in the lower second premolar and full crown on the molar
tooth. This bridge has been present for 20 years. The movable joint can be seen between the
pontic and the minor retainer.
A conventional bridge with an MOD gold inlay as the minor retainer and a full gold crown as the
major retainer

Complete crown (full crown), partial crown, intracoronal or minimum

preparation retainers?
The choice between complete and partial crown retainers for posterior
conventional bridges should always be considered and will depend upon a full
assessment of all the circumstances of the case.
It should not be made from habit. It will be found that even after a full
assessment, 80–90% of conventional bridge retainers will be full crowns, but
for the remaining 10–20% there are sound reasons for
choosing a partial crown.
Intracoronal retainers are used only as minor retainers except for very
retentive MOD protected cusp inlays / onlays.
With sufficient enamel available the minimum preparation retainers should be
considered.
When an anterior tooth is intact a minimum preparation retainer is more
conservative of tooth tissue than a complete crown, and so is the
preferred choice whenever possible.

Fixed Prosthodontics ( C & B ) 3 Dr. Mohsen Al-Hamzi

 Pontic Design
Definition:
It is that part of bridge (Fixed partial denture) which replace the lost natural
tooth.

Pontic Function:
Pontics are designed to serve the three main functions of abridge:
1- To improve appearance.
2- To stabilize the occlusion.
3- To improve masticatory function.
Restore function and appearance compatible with continued oral health and
comfort.

Pontic Material ( Table – 2):

Pontic may be metal-ceramic, full metal, or resin processed to metal (less

commonly today).
Glazed porcelain pontic is cleanable, hygienic, and preferred touching the
edentulous ridge.
Highly polished gold with a mirror-like finish are preferred for tissue contact.
Resin should not be used on pontic near the tissue.

Table- 2. Available pontic systems.

Advantages Disadvantages Indications Contraindications
Metal- Esthetic. Difficult if an Most situations Long spans with high
ceramic Biocompatible. abutment is not stress.
Straightforward metal-ceramic. Less
procedure strong than all-metal
Resin- Straightforward Poor abrasion Long-term Definitive
veneered procedure. resistance. Staining at provisional. restorations.
resin-metal
interface.
Permeable to oral
fluids.
All-metal Strength. Non esthetic Mandibular Where Esthetics is
Straightforward molars, important.
procedure especially under
high stress .
Bruxism.

Pontic Tissue Contact

Fixed Prosthodontics ( C & B ) 4 Dr. Mohsen Al-Hamzi
The extent and shape of pontic. Excessive tissue contact is a major factor in
the failure of bridge. The once popular practice of scraping the ridge on the
cast to obtain close adaptation of the pontic with tissue compression is not
indicated, because the pressure on the ridge is cause inflammation. The area
of contact between the pontic and the ridge should be small and convex. (Fig
– 2-A), and there must be no space between pontic and soft tissue (Fig – 2-B),
sometimes if there is no contact, may surrounded by hypertrophied tissue.
If the tip of the pontic extends past the mucogingival junction, an ulcer will
form there. (Fig – 3-A).
The tip of the pontic must be restricted to keratinized gingiva. (Fig – 3-B).

Pontic Cleanability and size.

The mesial, distal and lingual embrasures of the pontic should be wide open to
allow the patient easy access for cleaning, and the contact between the pontic
and tissue must allow passage of dental floss from one retainer to other. (Fig –
4). Also interproximal brushes are excellent for cleaning the gingival
embrasures around pontics. (Fig. – 5).
Give the patient time to learn the techniques cleaning.
Pontic designed for the appearance zone, must produce the illusion of being
tooth, esthetically, without compromising cleanability.
The pontic should be on as straight line as possible between the retainers to
prevent any torque of the retainers and/or abutments.
The pontic should be slightly narrower than the natural tooth. (i.e. place it on
the interabutment axis.)

Fixed Prosthodontics ( C & B ) 5 Dr. Mohsen Al-Hamzi

Fixed Prosthodontics ( C & B ) 6 Dr. Mohsen Al-Hamzi
 Types of Pontics.
1- Saddle Pontic:
It is a pontic with a concave fitting surface that overlaps the residual ridge
buccally and lingually. (Fig – 6-A). This type should be avoided, because
the saddle is impossible to clean, and causes tissue inflammation.

(Fig – 6 ).

2- Ridge lap Pontic:

It is like a saddle pontic but the contact with the ridge, extends beyond the
midline of the edentulous ridge, or a sharp angle at the linguogingival
aspect of the tissue contact. (Fig – 7 ).

(Fig – 7 ).

3- Modified Ridge lap Pontic:

This design gives the illusion of a tooth, but it possesses all convex
surfaces for ease of cleaning. It is prevent food impaction and minimize
plaque accumulation, and the tissue contact is narrow mesiodistally and
faciolingually.
It is used on anterior or posterior teeth. Whenever possible, the contour of
the tissue-contacting area of the pontic should be convex. (Fig – 8-A,B).

Fixed Prosthodontics ( C & B ) 7 Dr. Mohsen Al-Hamzi

 (Fig – 8 )

4- Hygienic or Sanitary Pontic:

This type has no contact with the edentulous ridge (Fig – 9), it is used in
the non esthetic zone, particularly for replacing mandibular first molars. It
restores occlusal function and stabilizes adjacent and opposing teeth. If
there is no requirement for esthetics, it may be made entirely of metal.
The occlusogingival thickness of the pontic should be no less than 3.0 mm,
and there should be adequate space under it to facilitate cleaning.
The hygienic pontic is made in an all-convex configuration faciolingually
and mesiodistally, for easer flossing. (Fig – 10). The round design
describes as a “fish belly”. (Fig – 11-A).
An alternative design, in which the pontic is made in the form of a concave
archway mesiodistally. (Fig – 11-B).
An esthetic version of this pontic can be created by veneering with
porcelain.
This design has been called an “arc-Fixed P.D” a “modified sanitary
pontic” or “Perel pontic”

Incorrect Correct

(Fig – 11) (Fig – 10) (Fig – 9)

Fixed Prosthodontics ( C & B ) 8 Dr. Mohsen Al-Hamzi

5- Conical Pontic:
It is rounded and cleanable, but the tip is small in relation to the overall size
of the pontic. It is well suited for use on a thin mandibular ridge (Fig –12A)
However when used with a broad, flat ridge, tendency to collect debris.
(Fig – 12-B). It is used over thin ridges in the nonappearance zone.

A B

(Fig – 12 )

6- Ovate Pontic:

It is a round-end design currently in use where esthetics is a primary

concern.
The tissue-contacting segment of the ovate pontic is bluntly rounded and it
is set into a concavity in the ridge. (Fig – 13).
The concavity can be created by placement of a provisional bridge with the
pontic extending one-quarter of the way into the socket immediately after
extraction of tooth.

(Fig – 13)

Fixed Prosthodontics ( C & B ) 9 Dr. Mohsen Al-Hamzi

 Connectors.
The connector is that part of a fixed partial denture (FPD)or
splint that joins the individual components (retainers and
pontics) together. This can be accomplished by a nonrigid or
more commonly, a rigid connector.

Fixed or Rigid Connectors: (Fig 1)

There are three types (Cast, Soldered, Porcelain.).

1. Cast connectors:
Cast connectors are made by wax patterns of the retainers
and pontics connected by wax, so the bridge is cast in a
single piece.
These connectors are stronger than other types.

2. Soldered connectors:
These type are used if the pontics and retainers have to be
made separately.
This is necessary when they are made of different
materials, for example, a complete gold crown retainer
with a metal – ceramic pontic.

3. Porcelain connectors:
Porcelain connectors are used only in conjunction with all
porcelain fixed partial dentures.

Non – Rigid Connectors ( Fig 2):

The majority of non-rigid connectors are made in the laboratory.

A wax pattern is produced for the minor retainer with a female
attachment prepared in the wax, the retainer is cast and the

Fixed Prosthodontics ( C & B ) 10 Dr. Mohsen Al-Hamzi

shape of the attachment refined with a tapered bur. The pontic is
then waxed up with a male portion to fit into this attachment,
cast and the two parts of the movable joint fitted together on the
working cast before the bridge is taken to the chair side for try-
in.

Fixed Prosthodontics ( C & B ) 11 Dr. Mohsen Al-Hamzi

Fig 2- A-Tenon-mortise connectors (Male &Female component or
Dovetail connectors).
B- Split connectors. C-Cross pin and wing connectors. D-Loop
connectors.

More information
1- Fundemental of prosthodontics (Shillinburg latest edition.)
2- Contemporary Fixed prosthodontics (Rosenstiel et al.).
3- Planning and Making Crown and Bridges (Smith et al)

Fixed Prosthodontics ( C & B ) 12 Dr. Mohsen Al-Hamzi