Simple Bridgework

Question 1

What are the basic principles that must be considered when planning bridgework?

Answer 1

Caries removal, keep maximum sound tooth tissue, maintain pulpal & periodontal health, restore form and function, longevity, aesthetics, occlusal stability, must be cleanable, and thorough case assessment.

Question 2

What specific factors must be assessed during bridgework planning?

Answer 2

Abutment status, contact points, alignment (palatal/lingual tilting), patient fatigue, path of insertion, span, pontics, aesthetics & speech, retention, and contingency plan for failure.

Question 3

What is the “Daughter Test” in bridgework planning?

Answer 3

Asking yourself: “Knowing what I know about this proposed dentistry, would I carry out this treatment on my own son/daughter’s teeth, or my own teeth, or my partner’s/parent’s/friend’s teeth?”

Question 4

What information must be provided to patients when planning bridgework and obtaining consent?

Answer 4

Study casts/digital planning, diagnostic wax ups, reasonable alternatives (no treatment, implants, dentures, different bridge types), costs & timescale, aesthetic expectations, longevity/replacement cycles, effects on tooth health/symptoms, and materials.

Question 5

What are the five main types of bridges?

Answer 5

Adhesive (resin-bonded), conventional fixed bridge, conventional cantilever bridge, fixed-moveable bridge, and others (spring cantilever, natural tooth bridge, bridge on telescopic crowns).

Question 6

What are the advantages of adhesive bridgework?

Answer 6

Minimal or no preparation, often no anaesthetic needed, less expensive, less surgery time, can be used as provisional restoration, if fails usually less destructive than alternatives.

Question 7

What are the disadvantages of adhesive bridgework?

Answer 7

Rigorous clinical technique required, metal shine-through, can debond repetitively, chipping porcelain, occlusal interferences, no trial period possible.

Question 8

What are the advantages of conventional bridgework?

Answer 8

Useful when teeth heavily restored, good aesthetics, can temporise & cement provisionally, strong so useful in high loads, debonds less than adhesive, transfers load to roots.

Question 9

What are the disadvantages of conventional bridgework?

Answer 9

Destructive of tooth tissue, expensive, long appointment times, requires very high standard of oral health, failure may result in tooth loss, risk of pulpal damage.

Question 10

Why are adhesive bridges generally designed with one wing rather than two?

Answer 10

Two abutments increase torque on the least mobile abutment and risk a “sprung” bridge. However, two wings may be used pragmatically for splinting, diastemas, periodontal mobility, or small teeth.

Question 11

What are the ideal case selection criteria for adhesive bridges?

Answer 11

Low occlusal forces, missing lateral incisors, splinting role, and large occluso-gingival height.

Question 12

What are the cautions/contraindications for adhesive bridges?

Answer 12

Bruxists, canines as pontics, lack of posterior support, deep overbite, small occluso-gingival height, and lack of enamel.

Question 13

What are the key preparation features for anterior adhesive bridges?

Answer 13

Only prep if needed, large area of enamel without compromising aesthetics (180° wrap around), supragingival chamfer 0.5mm, cingulum rest, parallel grooves for path of insertion/removal, guide planes mesial & distal, 0.5mm occlusal space

Question 14

What is crucial for problem-solving with adhesive bridges regarding pontic design?

Answer 14

Pre-operative assessment of planned pontic shape AND adjacent teeth is crucial. Use of cleats for accurate cementation may be needed.

Question 15

When would you use a conventional fixed bridge over an adhesive bridge?

Answer 15

Deep overbite, aesthetic failure of previous bridge, cannot keep previous bridge clean, or presence of buccal concavity.

Question 16

What are the critical considerations for conventional cantilever bridges?

Answer 16

Abutment health is critical, occlusion (torque on pontic), and caution with distal free end saddle cantilevers.

Question 17

What are the indications for fixed-moveable bridges?

Answer 17

Malaligned abutment teeth, pier abutment, combination of materials needed, mobile teeth, and spacing issues.

Question 17

When are spring cantilever bridges useful conventionally?

Answer 17

When spacing is present between upper incisors, when adjacent teeth are unrestored, when a posterior tooth would provide a suitable abutment (already heavily restored).

Question 17

What are the concerns with fixed-moveable bridges?

Answer 17

Clinical & technical complexity, oral hygiene challenges, and typically should be referred to a specialist.

Question 18

Why are spring cantilever bridges considered non-ideal?

Answer 18

They are complex dentistry, difficult to clean under the arm, and typically should be referred to a specialist.

Question 19

What is the key feature of bridges on telescopic crowns?

Answer 19

Complex dentistry where telescopic crowns are aligned & cemented definitively, bridge cemented temporarily to allow removal & reinspection, requires contingency plans for failure, and should be referred.