Bridge to smile!

Fixed Partial Denture/ Porcelain-fused-metal bridge on posterior teeth clinical step by step:


1st visit in Clinic:

• History taking and examination
• Tooth shade selection
• Primary impression using alginate impression material on stock tray (spray with tray adhesive); upper & lower

1st lab work:

• Fabricate diagnostic cast/ primary cast
• Wax up of the missing tooth

2nd visit in Clinic:

• Prepare silicone index on diagnostic cast; to fabricate temporary bridge later

Photo is for anterior index

• Tooth preparation on both abutment:
• occlusal: shoulder diamond bur, reduce 2mm(functional cusp) and 1.5mm(non-functional cusp)
• facial: shoulder diamond bur, reduce 1.2mm
• lingual: chamfer/round diamond bur, reduce 0.5mm
• interproximal: needle diamond bur to open contact
• Gingival sulcus retraction; to achieve lateral space to record secondary impression & achieve hemostasis 
• min 4 min. and max 10 min. (or necrosis will happen)
• using 2 retraction cord (size 0 or 00); two cord technique
• impregnated with hemostatic agent
• start at distal/mesial of tooth
• use the smallest plastic instrument
• moisten the cord before removal
• Secondary Impression:
• assistant: mix silicone putty material and place on sectional tray (coat with silicone tray adhesive)
• operator: place silicone wash material using auto mix gun around the abutment (working area) and on tray 

This is impression of anterior abutment. You only need to place the silicone on your working area!

Check the recorded flush!

• Occlusal registration; use base plate wax/ PVS 
• Fabricate temporary bridge using silicone index with acrylic material

This is acrylic injection on index for temporary crown. For bridge, place acrylic on both abutments and pontic area!

• Place the temporary bridge using GIC temporary cement

• Prescribe your patient with chlorhexidine mw until next visit (2 times per day)

2nd lab work:

• Fabricate secondary cast using die stone
• Ariticulate upper and lower cast on articulator using occlusal registration 
• Fabricate metal frame work

3rd visit in Clinic:

• Try in metal frame work:
• check the high spot on the basal seat using green occlu spray (hard tissue - hard tissue)

• recheck after correction; maintain the 0.5mm metal width using dental gauge/ caliper

3rd lab work:

• Add porcelain on metal framework using shade selected
• Ovate pontic gives good esthetic

4th visit in Clinic:

• Check bridge on die
•  Check PFM bridge intraorally:
• check high spot under pontic using pressure indicating paste (hard tissue - soft tissue)
• check occlusion using articulating paper and shimstock
• check proximal contact using floss (if tight; grind and polish, if open contact; send to lab to add porcelain)
• do not try to correct anything on basal seat metal; we had done in in previous visit
• Finishing and polishing using straight hand piece
• Place the bridge with GIC permenant cement

5th visit in Clinic:

• Recall after 3 months

General idea for PFM bridge!

Life is short. Smile while you have teeth!😜

Root Canal Theraphy

Basic steps to do Root Canal Treatment:

EWL RADIOGRAPH

1) Caries removal

2) Canal access

3) Pulp extirpate


4) Straight line access; deroofing etc


5) Cleaning & Shaping; coronal flaring and canal preparation

- IAF at least #15

CWL RADIOGRAPH

- MAF increase #size by 3, CWL/ same length as IAF; apical enlargement
- FAF increase #size by 5, decrease by 1mm each length; step back make tapered root
- Irrigate and recapitulate (using #15, +1mm of CWL) each steps


6) MGP = FAF size/ 3 times bigger then MGP; feel tug back sensation

MGP RADIOGRAPH

7) Obturation
- Add accessories GP
- Lateral compaction!
- Cut GP
- Vertical compaction!

POST RADIOGRAPH


8) Filing/ final restoration

P/s: all above are general procedures to perform RCT, each cases in the clinic have different approaches; based on health of patient, condition of tooth, etc. So all these steps are not concluded. Please refer to your current supervisor.