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Crowns, Fixed Bridges and Dental Implants Guidelines

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Crowns, Fixed Bridges and Dental Implants Guidelines CROWNS, FIXED BRIDGES AND DENTAL IMPLANTS GUIDELINES THE BRITISH SOCIETY FOR RESTORATIVE DENTISTRY INTRODUCTION Standards in healthcare are of fundamental importance. Evidence-based dentistry, audit and peer review are essential components of effective clinical practice. To assist with these processes, the These guidelines should not WHY IS IT THAT BSRD perceives a need for guidelines be considered prescriptive or on acceptable levels of care in didactic. Obviously, there will be restorative dentistry. Some guidance circumstances, encountered during is already available from our sister patient management, when the TEETH DECAY? organisations, the British Endodontic “ideal” treatment may not be Society, the British Society of possible nor the outcome optimal. Periodontology and The British In addition, new techniques and YOU DON’T ALWAYS HAVE TO GO Society of Prosthodontics, within materials will become available their spheres of interest. which will bring about change. This document is intended to act However, it is the Society’s belief TO THE DOCTOR’S TO HAVE HOLES as a stimulus to members of the that these standards can and Society and to the profession to seek should be the goal during attainable targets for quality in fixed management of the majority of IN YOUR ARM STOPPED UP DO YOU? prosthodontics. It is hoped that this clinical cases. document from the Society will assist in the pursuit and maintenance of IT’S A FLAW IN THE DESIGN. high standards of clinical practice. Originally published in 1993, updated in 2007 and 2013. ALAN BENNETT 2 crowns, fixed bridges and implants GUIDELINES crowns, fixed bridges and implants GUIDELINES 3 INDICATIONS ALTERNATIVES TO DEFINITION OF A THE RATIONALE The decision to provide a crown or fixed bridge whether tooth or implant - supported depends on many factors, including: FIXED BRIDGE • The motivation and aspirations of In all situations, the clinical CROWNS AND Any dental prosthesis that is luted, implant abutments that FOR THE USE OF: the patient. advantages and long-term benefits screwed or mechanically attached or furnish the primary support for • The oral and general health of of crowns and fixed bridges should otherwise securely retained to natural the dental prosthesis. CROWNS: FIXED BRIDGES: the patient. justify such treatment and outweigh teeth, tooth roots, and/or dental their disadvantages. They should only • To restore the form, function and • To replace one or more teeth of Tooth-supported bridges require the • The condition of the remaining The Glossary of Prosthodontic Terms J Prosthet Dent 2005; 94: 10-92 FIXED PROSTHESES appearance of teeth which are badly functional or cosmetic importance availability of sufficient abutments of be undertaken in those situations teeth and tooth tissues, the in which such advanced restorative broken down, worn or fractured to the patient. appropriate quality and prognosis. periodontal condition and oral Modern dentistry offers many For example, in the management Aspects of the provision of implant- care will clearly contribute to the oral to the extent that simpler forms of Either in the absence of adjacent hygiene maintenance. opportunities to provide direct and of the worn dentition, particularly based restorative dentistry are similar • More rarely, to prevent tooth restorations are contraindicated or suitable teeth or when they would health and welfare of the patient. indirect restorations which satisfy that damaged by erosive substances, to those for teeth whilst others movement and improve occlusal • Analysis of the benefits, have been found to fail in clinical not benefit from restoration, implant- The replacement of failed crowns aesthetic and functional requirements the use of full coverage crowns has require different considerations and stability. disadvantages and long-term service. supported prostheses should be and bridges and the teeth or of patients without the need for little to commend it as the first option skills. These guidelines will refer to consequences of providing a crown considered. Dental implants offer implants which support them should significant, if any, tooth preparation. for treatment. implant-supported crowns and fixed • To improve the form and appearance or fixed prosthesis. of unsightly teeth which cannot the benefit of being able to facilitate be conditional on an understanding Vital bleaching, composite resins, Dental implants may frequently be prostheses as necessary. • Complications which limit the be managed by more conservative tooth replacement without the of the aetiology and successful ceramic inlays and onlays and resin- the treatment of choice when The development of adhesive likelihood of clinical success. preventive management of the cosmetic procedures. need to involve teeth adjacent to retained bridges frequently have major missing teeth are to be replaced. techniques and the predictability of the edentulous area. Where implant • The skill and experience of the cause(s) of failure. • To reduce the risk of fractures roles in any treatment plan. The biological cost to the patient is dental implants reduce the need for placement and restoration are clinician. occurring in extensively restored teeth Where teeth are minimally or low when sufficient bone is available the removal of sound tissue as part of complicated and the use of tooth- including endodontically treated moderately restored at the time of to house them. restorative treatment. supported fixed bridgework is contra- posterior teeth. presentation, adhesive restorations indicated the use of removable partial are generally most appropriate. • More rarely, to alter significantly the prostheses will require evaluation by shape, size and inclination of teeth for both the dentist and the patient. cosmetic and functional purposes. • To restore a dental implant. 4 crowns, fixed bridges and implants GUIDELINES crowns, fixed bridges and implants GUIDELINES 5 AIMS • To determine the patient’s Patients with medical conditions may The clinical examination may be Other forms of special test Many clinical situations benefit from requirements and expectations and still be treated with implants following supported by special tests, which may include: the involvement of additional dental to gain an informed opinion of the advice from their physician. may include: • Dietary analyses. specialists or those with particular patient’s suitability for treatment skills. Such involvement should take • To complete a comprehensive clinical • Sensibility testing of teeth. • The use of diagnostic and provisional involving the use of crowns or fixed place prior to the establishment of examination which will include a • Radiographic examinations. appliances. prostheses. review of the clinical performance a treatment plan and may increase • Analyses of study casts mounted in • Direct observations of occlusal and • To obtain a history, which includes and mode of failure of any existing the options available to the patient. a semi-adjustable articulator in an masticatory function. details of all previous conditions and restorations. This will require a Implant-based treatment may be appropriate jaw relationship experiences of relevance including diagnosis of existing disease and an • Long-term monitoring against base- provided either by a single competent information pertaining to any assessment of the processes that • Assessments of the patient’s line study casts. operator or by a team lead by a adverse reactions to treatment, the have resulted in the need to provide response to initial instruction in Diagnoses may take time to establish prosthodontist and including a surgeon. administration of drugs and the use restorations and prostheses. oral hygiene procedures. and require the use of additional The need for inter-disciplinary provision of materials. • To analyse the effectiveness of special tests including dental and restoration of implants is based on • A medical history is mandatory for the patient’s control of their own investigations to stabilise or determine the complexity of the case and the skill all patients. Treatment involving the dental disease. a prognosis for one or more teeth. and wishes of the dentist providing the provision of dental implants should Any case considered to be beyond a restorative care. It is important that the additionally include questioning clinician’s capabilities and experience whole dental team is knowledgeable regarding the following recognised should be referred for further about dental implants. Training of risk factors: assessment, advice and possibly dental nurses, technicians and reception staff is mandatory. • Osteoporosis. treatment. • Bisphosphonate therapy. • Uncontrolled diabetes. • Smoking. • Radiotherapy. ASSESSMENT6 crowns, fixed bridges and implants GUIDELINES crowns, fixed bridges and implants GUIDELINES 7 AIMS DESIGN CONSENT CLINICAL RECORDS PREPARATORY • To establish the diagnoses, The design for tooth-supported The choice of material(s) should: • Has protocols to allow single Before finally agreeing to a It is important to obtain written In common with all other MANAGEMENT related clinical findings and fixed bridges should: • Allow the realisation of patients’ stage surgery, two stage surgery, particular treatment strategy, informed consent for all forms of documentation related to the Preparatory management TREATMENT treatment alternatives, together immediate placement, immediate • Be as simple and conservative cosmetic expectations, but not patients should be made aware of fixed prosthodontic treatment: this patient, clinical
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