Fixed Full Arch Prostheses

Definition and Function: Fixed Full Arch Prostheses: These are single-piece fixed restorations that extend across the arch, replacing missing teeth, splinting all support teeth together, protecting periodontal tissues, restoring aesthetic color and form to the patient, and offering comfortable chewing possibilities. Advantages: They immobilize weak teeth more reliably than other...
Asian dentist holding pen pointing to the dentures and is describing the problem of teeth.
Fixed Full Arch Prostheses
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Definition and Function:

  • Fixed Full Arch Prostheses: These are single-piece fixed restorations that extend across the arch, replacing missing teeth, splinting all support teeth together, protecting periodontal tissues, restoring aesthetic color and form to the patient, and offering comfortable chewing possibilities.

Advantages:

  1. They immobilize weak teeth more reliably than other types of restorations. Splinting factor delays or stops widespread and localized bone loss in the arch.
  2. A full-arch fixed splint provides much better force transmission than a straight partial-arch splint, creating no or very low-level lever movements.
  3. Smooth gingival termination and well-polished casting surfaces facilitate easy removal of bacterial plaque and protect gingival tissues. They also prevent recurrence of caries.
  4. In fixed full arch prostheses, patients can apply more occlusal force compared to a sectional prosthesis.

Indications:

  1. In cases of periodontal destruction where the gum has receded, and there is high mobility of teeth due to bone loss.
  2. In cases of traumatic occlusion (widespread abrasion, erosion, and attrition).
  3. In cases of acute dental decay.
  4. In cases of dental arch collapse.
  5. Indicated in cases of congenital tooth deficiencies and dental form anomalies.

Succinctly conveys the essential aspects of fixed full arch prostheses, including their definition, function, advantages, and indications. These prostheses play a vital role in restoring dental function and aesthetics in patients with extensive dental issues.

 

Reatment Sequence:

  1. Periodontal Treatment
  2. Endodontic Treatment
  3. Elimination of Trauma and Occlusion Balancing
  4. Fabrication of Fixed Restorations

Treatment Plan & Technique for Fixed Full Arch Restoration:

  1. Technique: Both arches simultaneously.
  2. Technique: Each half-arch (segment) individually and in successive sessions.
  3. Technique: Both half-arches simultaneously.

Details of Technique and Treatment Plan:

  1. Diagnosis
  2. Record the patient’s pre-preparation tooth color.
  3. Design the final restoration on models using diagnostic wax-up.
  4. In support tooth preparation, all teeth should be cut parallel to each other.
  5. Prepare temporaries. Tooth preparation and temporaries are prepared in approximately 4 appointments. Occlusion is maintained with uncut teeth in contact and temporaries.
  6. Record occlusal dimensions, tooth preparation, and face-bow registration. After segmental centric records are taken, work on the articulator to prepare the temporaries.
  7. Once the temporaries’ articulation in the mouth is adjusted, take another impression and face-bow record.
  8. Final impression and working models: Take 3 sets of full-arch final impressions for each arch. Each time, record the tooth preparation of one arch, leaving the temporaries on the other side.
  9. Prepare working models for wax patterns.
  10. Proceed to metal substructure preparation and porcelain application using known techniques.

Advantages of the Technique:

  1. The prepared temporaries provide information about the color and form of the final restoration.
  2. Vertical and centric relations are maintained.
  3. The need for occlusal records is minimized.
  4. Temporaries allow for adjustments in vertical dimension if needed. They also serve as stable and aesthetic interim prostheses.

 

Here are the notes on design principles related to Ante’s Law, bridge bodies and connectors, fixed arch substructure design, and aesthetic design rules:

  1. Ante’s Law and Its Modifications Regarding Design Principles:

  • Ante’s Law: “The total pericemental area of the abutment teeth for a fixed bridge should be equal to or greater than the pericemental area of the teeth being replaced.”

Conditions of Validity:

      1. Ideal crown-to-root ratio of the abutment teeth.
      2. Absence of periodontal problems.
      3. Satisfactory morphological character of the abutment teeth.

Modifications of Ante’s Law:

  • Increased bone loss due to periodontal disease.
  • Following root resections.
  • In cases of tooth mobility.
  • Disruption of opposing arch relationship, or presence of large lever movements in arch forms, requiring an increase in the number of abutment teeth.

Design Principles Related to Bridge Bodies and Connections:

  • The number of bridge bodies and connectors (connectors) in fixed arch prostheses is as important as the number of supporting teeth.
  • The use of prefabricated body examples can reduce metal costs and provide better connections.
  • Changes in the width and height of the connection can affect the strength of the bridge.

Fixed Arch Substructure Design Rules:

  • Full arch restorations must passively fit on the abutment teeth.

    Measures in the Laboratory:

      1. Application of die spacer on the model to ensure the bridge fits comfortably.
      2. To prevent distortion during casting and porcelain firing stages, a 2mm diameter connecting bar should be designed between the most distal units.
      3. The arch casting should not be excessively voluminous.
  1. Aesthetic Design Rules:

  • The aesthetic design of the upper anterior teeth is of great importance.

    Factors to be controlled and communicated to the technician during design:

      1. Midline.
      2. Dental axes.
      3. Gingival curvature.
      4. Apex of the gingival curvature.
      5. Interdental spacing.
      6. Interdental contact point.
      7. Tooth shape.
      8. Incisal edge.
      9. Angle between incisors.
      10. Grooves and pits.
      11. Smile, lower lip line.
      12. Curvature formed by all incisal edges.

These notes provide detailed insights into the key design principles in prosthodontics, focusing on the biomechanical and aesthetic aspects essential for successful fixed dental prosthesis planning and implementation.

 

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