Ministry of High Education 2

Ministry Of High Education
And Scientific Research
Tishk International University
Faculty of Dentistry
Bone resorption comparison in bridge side and non-bridge side on

OPG
By:
Marwa Latif Fatih
Nakhshin Khalid Hamad
Supervised by:
Prof.Dr.Jabbar Husain Kamal
Project submitted in Partial Fulfillment of the
Requirements for the degree of
Bachelor in dental surgery (BDS)
Hawler 2018-2019
1
Dedication
……………………
Every challenge work needs self-efforts as

well as guidance of elders especially those
who were very close to our heart.
Our humble effort we dedicate to our sweet
and loving
Father & Mother,
Whose affection, love, encouragement and

prays of day and night make us able to get
such success and honor,
Along with all hard working and respected
Teachers.
2
ACKNOWLEDGMENTS
Our grateful and deepest thanks to God for giving us the strength and patience to
complete this research.
Our deepest gratitude and appreciation goes to our supervisor Prof. Dr .Jabbar
Husain for his helpful comments, advices and kindness throughout our work and
writing of this thesis and for being generous with his knowledge and experience
and time in supervising this work.
We would like to specially thank Dr.Bzhar for his effort with us, for his great helps
and kind advice for improving our thesis.
We would like to thank Dr. Rebaz for statistical analysis.
We want to thank Dr.Rebuar Fadhil for helping us.
We would like to thanks Oral radiology and Diagnosis department for their help.
Finally, we would like to express our deep gratitude to our families for their
continuous support, helps which made everything possible.
3
Abstract
The aim of study: This study designed for find radiographical evaluation of bone
resorption around abutment teeth for fixed bridge construction, and evaluation
the effects of age, sex, arch and number of missing area and amount of bone
resorption.
Background: Fixed dental bridge, it is fixed prosthetic restoration used to restore

one or more missed teeth and placed on abutment which is natural teeth.
Material and method: In the present work, the study samples were collected
randomly from patients who had fixed dental bridge and attended to the oral
diagnosis and radiology department in College of Tishik International University,
in Erbil during the period between ‘’October 2018 March 2019’’. At first
questioners have been filled for those patients who have posterior dental fixed
bridge either they were ( metal or dental PFM or zircon ) all were either single
missed or double missed teeth in molar and premolar region , the questioner
included two age group which were between (20-39)-(40-60) and all the name
,age, gender, number of missing unit , and location of fixed dental bridge were
recorded, and radiographs were viewed on computer and measurement done for
all the radiographs by NEWTOM program.
Result: In this study 242 cases were recorded from total number of cases which
have been done. There were 44.8% male and 55.2% female.
According to age groups from (20-39) was 16.2 % and (40-60) was 83.8%according
to missing unit , one missing unit 65.6% , two missing unit 34.4% according to the
site of the bridge , upper right 29.9 % , upper left 30.7% lower left 14.5% , lower
right 24.9% according to non-bridge site , upper right 21.6 % , upper left 2.4%
lower left 39.8% , lower right 26.1%.
4
Conclusion: According to this study, bone resorption comparison between bridge
side and non-bridge side is significant and higher rate of bone resorption have
been recorded in non-bridge side.
Table of Contents
List of Table ................................................................................................................................................... 8
Chapter one: ............................................................................................................................................... 10
Introduction ................................................................................................................................................ 10
1.1 Aim of study ...................................................................................................................................... 12
Chapter Two:............................................................................................................................................... 13
Literatures Review ...................................................................................................................................... 13
2.1Terminology: ...................................................................................................................................... 13
2.2Restoration types: .............................................................................................................................. 14
2.2.1-Crown:........................................................................................................................................ 14
2.2.2-Bridge ......................................................................................................................................... 14
2.2.3-Inlay ........................................................................................................................................... 15
2.2.4-Onlay .......................................................................................................................................... 15
2.2.5-Veneer ....................................................................................................................................... 15
2.3Dental bridge: .................................................................................................................................... 15
2.3.1Advantage: .................................................................................................................................. 15
2.3.2Disadvantages: ............................................................................................................................ 16
2.3.3Dental bridge Indications ............................................................................................................ 16
2.3.4Contraindications: ....................................................................................................................... 17
2.3.5Types of bridge: .......................................................................................................................... 17
2.4 Case selection and treatment planning: ........................................................................................... 23
2.5Selection and evaluation of abutment teeth: .................................................................................... 24
2.6Biomechanical Considerations: .......................................................................................................... 25
2.7Types of artificial plastic teeth: .......................................................................................................... 26
2.8 A pontic aims..................................................................................................................................... 27
2.9Types of bridges according to durability:........................................................................................... 28
2.10Types of bridges according to material: .......................................................................................... 29
2.11Clinical stages of bridgework ........................................................................................................... 30
5
2.12Restoration fabrication .................................................................................................................... 32
2.13Bridge failures .................................................................................................................................. 33
2.14Problems with abutment teeth: ...................................................................................................... 34
2.14.1Periodontal disease:.................................................................................................................. 34
2.14.2Problem with the pulp: ............................................................................................................. 34
2.14.3Caries: ....................................................................................................................................... 35
2.14.4Fracture of the prepared natural crown or root:...................................................................... 35
2.14.5Movement of the tooth: ........................................................................................................... 35
2.15Design Failures: ................................................................................................................................ 36
2.15.1Inadequate bridge design: ........................................................................................................ 36
2.15.2Under-prescribed bridges: ........................................................................................................ 36
2.15.3Over-prescribed bridges: .......................................................................................................... 36
2.16 Marginal insufficiencies: ................................................................................................................. 38
2.16.1Positive ledge (overhang): ........................................................................................................ 38
2.16.2Negative ledge: ......................................................................................................................... 38
2.16.3Defect: ....................................................................................................................................... 39
2.16.4Poor shape or shading : ............................................................................................................ 39
2.16.5Occlusal problem: ..................................................................................................................... 40
2.17Oral manifestations of bridge failures: ............................................................................................ 40
2.18Management options include: ......................................................................................................... 41
2.19Ferrule effect on preparation: ......................................................................................................... 41
2.20Previous study:................................................................................................................................. 42
Chapter Three: ............................................................................................................................................ 45
Materials And Methods .............................................................................................................................. 45
3.1 Materails ........................................................................................................................................... 46
Chapter four: ............................................................................................................................................... 52
Results ......................................................................................................................................................... 52
Chapter five:................................................................................................................................................ 60
Discussion.................................................................................................................................................... 60
5.1 descriptive statistics: ......................................................................................................................... 60
5.2 inferential statistics: .......................................................................................................................... 61
5.3 compare to other studies.................................................................................................................. 64
6
Chapter six: conclusion and suggestion. ..................................................................................................... 68
6.1-conclusion ......................................................................................................................................... 68
6.2 Suggestion: ........................................................................................................................................ 69
References .................................................................................................................................................. 70
List of figures
Figure 1:orthopantogram:new tom. ........................................................................................................... 46
Figure 2:NEWTOM programm. ................................................................................................................... 47
Figure 3:orthopantogram. .......................................................................................................................... 47
Figure 4:measurment arrow. ...................................................................................................................... 48
Figure 5:measurment of bridge site. .......................................................................................................... 48
Figure 6:measurment of bridge side and non bridge side ......................................................................... 49
Figure 7:questionary accoridng to age (20-39) ........................................................................................... 50
Figure 8:questionary according to age (40-60) ........................................................................................... 51
Figure 9:bone resorption between bridge side and non bridge side ......................................................... 53
Figure 10:rate of bone resorption in male patient ..................................................................................... 54
Figure 11:rate of bone resorption in female patient .................................................................................. 55
Figure 12:rate of bone resorption in bridge site......................................................................................... 56
Figure 13:rate of bone resorption in non-bridge site ................................................................................. 56
Figure 14:rate of bone resorption between each jaw in bridge site .......................................................... 57
Figure 15:rate of bone resorption bewtween each jaw in non bridge side ............................................... 58
Figure 16:distribution of case according to sex. ......................................................................................... 58
7
List of Table
Table 1:Descriptive data of participant among bridge and non-bridge site ............................................... 52
Table 2: Comparison of bone resorption between bridge and non-bridge sides. ...................................... 53
Table 3:Bone resorption of bridge and non-bridge sides for male patients............................................... 54
Table 4:Bone resorption of bridge and non-bridge sides for male patients............................................... 54
Table 5:: Difference in bone resorption of bridge and non-bridge sides according to age groups of the
patients. ...................................................................................................................................................... 55
Table 6:: Difference in bone resorption of bridge and non-bridge sides according to age groups of the
patients. ...................................................................................................................................................... 57
Table 7:Comparison of bone resorption in upper and lower jaws among bridge site. .............................. 57
Table 8: Comparison of bone resorption in upper and lower jaws among bridge site. ............................. 58
8
List of abbreviation
ICP Intercuspal position
PMF Porcelain fused to metal
CAD Computer aided drawing
CAM Computer aided modeling
FDP Fixed dental prosthesis
OPG Orthopantogram
LSFDPs Long-span fixed dental prosthesis
TMJS Tempromandibular joints
GIC Glass inomer cement
9
Chapter one:
Introduction
Fixed prosthodontics is the science and art of reestablishing harmed teeth with
cast metal, metal-artistic, or every single earthenware rebuilding and of
supplanting missing teeth with fixed prostheses utilizing metal-fixed prosthetic
teeth ( pontics ) or metal-ceramic crowns over implant. Effectively treating a
patient by methods for fixed prosthodontics requires an astute blend of
numerous parts of dental treatment: patient training and the anticipation of
further dental sickness, sound diagnosis, periodontal treatment, operative
abilities, occlusal contemplations, and, some of the time, arrangement of
removable complete or halfway prostheses and endodontic treatment.
restoration in this field of dentistry can be the best administration rendered for
dental patients or the most exceedingly awful insult executed upon them. The
way taken relies on one's learning of sound biologic and mechanical standards,
the development of manipulative abilities to actualize the treatment plan, and the
advancement of a basic eye and judgment for evaluating subtlety. As in all fields
of the mending expressions, there has been gigantic change here of dentistry as
of late. Improved materials, instruments, and methods have made it feasible for
the present administrator with normal aptitudes to give an administration whose
quality is on a standard with that gave just by the most skilled dental specialist of
years gone. This is possible be that as it may; just if the dentist has an intensive
foundation in the standards of remedial dentistry and close information of the
systems required .The extent of fixed prosthodontics treatment can run from the
restoration of a single tooth to the restoration of the whole occlusion. Single
teeth can be reestablished to full capacity, and improvement in feel can be
accomplished. Missing teeth can be supplanted with fixed prostheses that will
improve patient comfort and masticatory capacity, keep up the wellbeing and
honesty of the dental arches, and, in numerous cases, raise the patient's mental
self portrait. It is likewise possible, using fixed dental prosthetic, and to render an
ideal occlusion that improves the orthopedic dependability of the
10
temporomandibular joints (TMJs). Then again, with inappropriate treatment of
the occlusion, it is possible to make disharmony and harm to the stomatognathic
framework. in dentistry, Ante's law alludes to a gathering of recommendations
identified with crown-to-root proportion set forth by Irwin H. Risk, in a
proposition paper he wrote in 1926.{ Michigan,1926]
Fixed prosthodontics is worried about reestablishing teeth utilizing rebuilding

efforts that are fixed into the patient's mouth. They are ordinarily made in a lab in
the wake of taking impressions (molds) for the professional technician to work
with. They are otherwise called "indirect restoration".
Indirect rebuilding efforts can be utilized to reestablish and fix single or various
teeth, and can be utilized to reestablish generally little spaces between the teeth.
Indirect rebuilding efforts are generally strong contrasted with fillings that can be
put at the chair side. Frequently the aberrant rebuilding efforts can be made to
look better (more aesthetic). It is hard to state to what extent fixed rebuilding
efforts should last. In the event that they are arranged, executed and kept up
accurately, they could last anyplace up to 10-12 years, and maybe more. Ante's
law hypothesized that: "total area of abutment teeth should be equal or more
than area of tooth or teeth that should be replaced "Working from this reason,
later cases were made that: "the length of the periodontal membrane attachment
of the abutment tooth should to be somewhere around one half to two third of
that of its typical root attachment" ,Because of these to a great extent unverified,
experimental ideas, numerous teeth were in this manner rejected from
reasonableness as a abutment for fixed partial dentures and twofold abutments
turned into a prevalent methods for conforming to Ante's law. Long-period
clinical preliminaries neglected to give proof to Ante's purported "law" and all
things considered, it tends to be reasoned that Ante's law as for teeth has been
refuted[ Greenstein G et al., 2007]
11
1.1 Aim of study
Radiographically evaluation for the effects of fixed bridge on bony support around
abutment teeth and the relation of age,gender,arch,span in patients who visited
dental clinic of Tishik International University of medical science Diagnosis and
Oral radiology department ,during 2017-2018.
12
Chapter Two:
Literatures Review
2.1Terminology:
Bridge: is fixed dental rebuilding (a fixed dental prosthesis) used to supplant one
or more ,fixed connect dental prosthesis that is completely joined to normal teeth
and replaces missing teeth.[Mitchell DA et al.,2014]
Abutment: The tooth that support and holds a dental prosthesis. [The Glossary of
Prosthodontics Terms: Ninth Edition 2017]
Pontic: The artificial tooth that replaces a missing characteristic tooth. [The
Glossary of Prosthodontics Terms: Ninth Edition 2017]
Retainer: The part connected to the abutment for maintenance of the prosthesis.
Retainers can be major or minor. [Planning and Making Crowns and Bridges,
Fourth Edition, CRC Press, 2006]
Unit: Pontics and abutment teeth are alluded to as units. The all out number of
units in an extension is equivalent to the quantity of pontics in addition to the
quantity of projection teeth. [Mitchell DA et al., 2014]
Saddle: The region on the alveolar edge which is edentulous where something
like one missing tooth is to be reestablished. [Planning and Making Crowns and
Bridges, Fourth Edition, CRC Press, 2006]
Connector: Joins the pontic to the retainer or two retainers together. Connectors
might be fixed or portable. [Planning and Making Crowns and Bridges, Fourth
Edition, CRC Press, 2006]
Span: The length of the alveolar edge between the normal teeth where the bridge
will be set. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press,
2006]
13
Abutment: The tooth or embed that underpins and holds a dental prosthesis.
[Planning and Making Crowns and Bridges, Fourth Edition, CRC Press, 2006].
Resin bonded bridge: A dental prostheses where the pontic is connected to the
surface of natural teeth which are either unprepared or minimally prepared. [
Shilling burg et al., 2014]
2.2Restoration types:
2.2.1-Crown:
A crown is utilized to cover a tooth and might be usually alluded to as a "cap."
Traditionally, the teeth to be crowned are set up by a dentist, and records are
given to a dental expert to build the prosthesis. The records incorporate models,
which are reproductions of a patient's teeth, and the impressions used to make
these models. There are a wide range of strategies for crown manufacture, each
utilizing an alternate material. A few strategies are very comparable, and use
either fundamentally the same as or indistinguishable materials. Crowns might be
made of gold or other comparable metals, porcelain, or a mix of the two. Crowns
made of Zirconia Oxide are being made increasingly well-known because of its
high translucency and toughness instead of chipping hindrances of porcelain
crowns.
2.2.2-Bridge
A dental bridge is utilized to span, or bridge, an edentulous area (space where
teeth are missing), more often than not by interfacing with fixed rebuilding efforts
on adjoining teeth. The teeth used to help the bridge are called abutment. A
bridge may also refer to a single-piece multiple unit fixed partial denture (various
single-unit crowns either cast or melded). The piece of the bridge which replaces
a missing tooth and connects to the abutment is known as a "pontic." For
numerous missing teeth, a few cases may have a few pontics.
14
2.2.3-Inlay
An inlay is a restoration which exists in the limits of the cusps. These rebuilding
efforts are viewed as more conservative than onlays or crowns in light of the fact
that less tooth structure is removed in tooth preparation as abutment. They are
generally utilized when tooth decimation is not exactly a large portion of the
separation between cusp tips. [Schneider et al., 2010]
2.2.4-Onlay
An onlay is a strategy for tooth rebuilding, which covers, secures or strengthens
at least one cusps .Onlays are strategies for reestablishing teeth in a indirectly
way. Onlays are regularly utilized when teeth present broad demolition because
of caries or to trauma. [Le Courrier du Dentiste, 2012]
2.2.5-Veneer
A veneer is a light layer of remedial material put over a tooth surface, either to
improve the aesthetics of a tooth, or to reestablish a harmed tooth surface.
Materials utilized for veneer may incorporate composite and porcelain. At times,
evacuation of tooth structure is expected to give adequate space to the veneer,
while now and then a rebuilding might be bonded to a tooth without tooth
surface reduction. [ Mitchell et al.,2016]
2.3Dental bridge:
2.3.1Advantage:
1) Return aesthetics (particularly important for anterior edentulous areas)
2) Reestablish function (mastication, speech)
3) Occlusal stability (prevent tilting, drifting, rotation and over-eruption of

adjacent/opposing teeth)
4) Patients acceptability
15
2.3.2Disadvantages:
1) Damage of tooth tissue (tooth preparation of abutments often requires
significant tooth preparation).
2) Pulpal harm (tooth preparation opens dentinal tubules providing a connection

between bacteria in the mouth and the pulp, Deep preparations can cause pulpal
injury).
3) Secondary caries (around crown edges, under deboned retainer wings and
tooth).
2.3.3Dental bridge Indications
1) Take a place of a single tooth or a small spanning space.
2) Good oral health station and impulse of patient to keep up oral healthiness.
[Ibbetson R et al., 2017]
3) Periodontal status of remaining dentition at a firm and acceptable level.

[Ibbetson R et al,. 2017]
4) Abutment teeth of best quality with slight restorations and enough surface
area and enamel current for adhesion. [Gulati JS et al.,2016]
5) Binding of periodontally compromised teeth to increase occlusal stability,

wellbeing and reduction of mobility. (Periodontally compromised teeth are also a
contraindication). [ Gulati JS et al.,2016]
6) As a method for fixed maintenance after orthodontic treatment or extraction.

[Gulati JS et al., 2016]
7) Patient with unacceptable for implants construction. This might be because of

poor bone proportions, cost or patient don not want to do implants. [Gulati JS et
al., 2016]
16
2.3.4Contraindications:
1) Dimension of saddle area excessively too long. [ Dayanik S, 2016]
2) Patients with Para function e.g. bruxism [ Dayanik S, 2016]
3) Mobile tooth raises hazard of de-bonding. [Gulati JS et al., 2016]
4) Maligned teeth causing in poor aesthetics and communal path of insertion.

[Gulati JS et al., 2016]
5) Abutment tooth quality insufficient for instance may have a diminished surface
region, reduced enamel or be deeply restored. [Gulati JS et al., 2016]
6) Increased danger of caries because of increased difficulty in maintaining oral

hygiene around the bridgework. [Gulati JS et al., 2016]
7) Increased danger of loss of vitality.
8) Allergy to base metal alloys e.g. nickel. [Gulati JS et al., 2016]
9) Poor patient inspiration. Active dental disease (caries, periodontal disease) and
poor oral clearance. [ Shillingburg et al.,2014]
2.3.5Types of bridge:
Conventional bridge: Conventional bridges are reinforced by full coverage
crowns, three-quarter crowns, post-retained crowns, onlays and inlays on the
abutment teeth. In these kinds of bridges, the abutment teeth need preparation
and reduction to provision the prosthesis. Conventional bridges are named
depending on the way the pontic (false teeth) is connected to the retainer.
[Bartlett D, Ricketts D, 2013]
Fixed-fixed bridges: A fixed-fixed bridge refers to a pontic which is connected to a

retainer at the two sides of the space with only single path of insertion. This sort
of design has a rigid connector at each end which connects the abutment to the
pontic. As the abutments are connected together rigidly it is critical that during
tooth preparation the proximal surfaces of the abutment teeth must be prepared
so that they are parallel to each other. [Planning and Making Crowns and Bridges,
2006]
17
Cantilever: A cantilever is a bridge where a pontic is only connected to a retainer
just at one side. The abutment tooth might be mesial or distal to the portion of
the pontic. [Planning and Making Crowns and Bridges, 2019]
Spring cantilever: The pontic and retainer are remote from one another and
associated by a metal bar. For the most part, a missing anterior tooth is
exchanged and reinforced by a posterior tooth. This design of bridge has been
succeeded. [Planning and Making Crowns and Bridges, 2009]
Fixed-movable: The pontic is firmly connected to a retainer at one side of the

span (major retainer) and connected via a movable joint at the other end (minor
retainer).
A major advantage of this type of bridge is that the movable joint can lodge the
angulation differences in the abutment teeth in long axis, which enables the path
of insertion to be irrespective of the alignment of the abutment tooth. [Bartlett D,
Ricketts D, 2013] This enables a more conservative approach as the abutments do
not require being prepared so those are parallel to one and other. Ideally the rigid
connector should attach the pontic to the more distal side to the abutment. The
movable connector attaches the pontic to the mesial side of the abutment,
enabling this abutment tooth limited movement in a vertical direction. [Planning
and Making Crowns and Bridges, Fourth Edition, 2006]
Adhesive bridge: An alternative to the traditional bridge is the adhesive bridge

(also called a Maryland bridge). An adhesive bridge used "wings" on the sides of
the pontic which connect it to the abutment teeth. Abutment teeth require minor
or no preparation. They are most often utilized when the abutment teeth are
entire and complete (i.e., no crowns or major fillings). [Shilling burg ET al.2014]
Combination Designs: The combination of elements of different conventional

bridge designs. A popular mixture design is the use of a fixed-fixed design with a
cantilever. [Planning and Making Crowns and Bridges, Fourth Edition, 2006]
Hybrid Designs: Bridges that includes elements of both conventional and

adhesive bridge designs. [Planning and Making Crowns and Bridges, 2006]
18
2.3.5.1 Conventional Bridge Designs
Fixed-fixed:
Advantages: [Planning and Making Crowns and Bridges, Fourth Edition,2006]
1) Extreme strength
2) Exact retentive.
3) Most preferable design for elongated spans.
4) Construction is moderately direct.
Disadvantages: [Planning and Making Crowns and Bridges, Fourth Edition, 2006]
Preparations necessity to be parallel which may require broad tooth preparation.

Weakens the tooth and dangers to injuring the pulp.
1) Achieving parallel preparations is thought-provoking. It is imperative to keep

away from undermines.
2) Abutments are real retainers need broad extensive preparation.
3) Cemented as a single unit which may be challenging.
19
Fixed-movable: [Planning and Making Crowns and Bridges, Fourth Edition, 2006]
Advantages:
1) Non-parallel abutments may be utilized which might prevent too much tooth
preparation.
2) Minor retainers are utilized so the preparations are more preserve of tooth
tissue.
3) Permit slight movements of teeth.
4) Cementation is more direct as components can be cemented distinctly
Disadvantage:
1) Not suitable for long spans.
2) Complex design for the laboratory to build.
3) Temporary bridge is complex to create.
Cantilever: [Planning and Making Crowns and Bridges, Fourth Edition, 2006]
Advantage:
1) Only one abutment tooth is necessary for conservative treatment.
2) Damaging parallel preparation is not required here.
3) Most suitable design when taking place of anterior.
4) Maintenance and oral clearance is calmer for the patient.
20
Disadvantage:
1) Span length restricted to one pontic because of leverage on the abutment

tooth.
2) Rigid design to avoid alteration or distortion.
3) Tipping or tilting of abutment teeth due to occlusal load.
2.3.5.2Resin Bonded Bridge Designs: [Planning and Making Crowns and Bridges, Fourth
Edition, 2006]
Fixed-fixed
Advantage:
1) Huge surface region providing better retention and stability.
2) Easily to construct in the laboratory.
Disadvantage:
1) Deboning which can permit secondary caries to mature underneath the failed
wing.
2) Tilted abutments may necessitate broad preparation to achieve parallelism and

adequate retention.
3) Ideally abutments should have be equally retentive which is hard to realize,

specially posteriorly when the retainers are a molar and premolar teeth.
21
Fixed-movable
Advantage:
1) Abutment teeth might be transfer freely.
2) The retention of a two retainers does not require being identical.
3) Minor retainer could be slightly retentive.
4) Breaks tilting of the posterior abutment.
Disadvantage:
1) Design not directed for anterior bridges.
2) Design not appropriate for extended spans.
3) More complex to build in the laboratory.
Cantilever
Advantage:
1) Most preserver of tooth tissue as slight if any preparation required on one

abutment only.
2) Design of choice for taking place single anterior.
3) Might be used for small posterior spans.
4) Straightforward to build in the laboratory.
5) Patients can keep up abundant oral clearance as it is simple and easy to clean.
22
Disadvantage:
1) Restricted retention due to slight surface area.
2) Hazard of deboning due to torquing load.
3) Suitable placing on cementation might be complex.
2.4 Case selection and treatment planning:

Case selection: Appropriate case determination is important while thinking about
the organization of fixed bridgework. Patient needs should be talked about and a
demanding patient history ought to be acquired. Replacement of missing teeth
with fixed bridgework may not generally be demonstrated and both patient
factors close by remedial variables ought to be considered before choosing if
giving fixed bridgework is suitable. [ Hemmings K, Harrington Z, April 2004] The
survival rate of bridgework can be influenced by the span of bridge needed, the
proposed position of the bridge, and the size, shape, number and condition of
planned abutment teeth. [ Bishop K et al,.2007] Furthermore, any active disease
including caries or periodontal disease should be treated and followed by a period
of maintenance to ensure patient consistence in keeping up suitable oral
hygiene.[ Maglad AS et al.,2010)] [Briggs P et al., 2012 ].
Study models mounted on a semi-movable articulator utilizing a face bow record

are a valuable guide to study occlusion prior to provision of a fixed prosthesis.
They may likewise be utilized to practice planned tooth preparation .Along these
lines a demonstrative wax up can be given to enable the patient visualize the last
prosthesis and to construct a silicone index. This index can be used to make a
temporary prosthesis.
23
2.5Selection and evaluation of abutment teeth: Multiple factors affect the
selection of suitable abutment teeth, these includes:
1. The size of potential abutment tooth, with larger teeth having an improved
surface region best for retention
2. Utilizing teeth with an established periodontal status
3. Favorable tooth angulation
4. Favorable tooth location
5. An suitable crown-root ratio. [ Gulati JS et al.,2016].
Carefulness abutment selection is basic for the success of bridgework. The

prosthesis must be fitting of tolerating occlusal load, which would normally be
established by the missing tooth as well as its normal occlusal force. These forces
are transmitted to the abutment(s) via the prosthesis .Vital teeth are chosen to
endodontically treat ones for bridge abutments. Endodontically treated teeth
have missing a great quantity of tooth structure, weakening them and making
them less able to tolerate additional occlusal force. Post crowns have been
presented in some studies to have a higher failure rate. [ Planning and Making
Crowns and Bridges, 2019]. For resin bonded bridges abutment teeth ought to in
a perfect world be unrestored and have enough enamel to support the metal
wing retainer. Also there must be suitable space to accommodate the minimum
connector height of 0.7mm. It is satisfactory for the abutment to be insignificantly
reestablished with little composite restorations provided they are sound. It is
advised to replace old composite restorations prior to cementation to provide
optimum bond strength via the oxide layer. [Shillingburg et al.2014] Teeth with
active illness such as caries or periodontal disease should not be utilized as
abutments until the sickness has been steadied .Once established periodontally
compromised teeth may be used as abutments, depending on the crown to root
ratio described below.
Ante's law, articulates that the roots of abutment teeth must have a combined
periodontal surface area in three dimensions that is more than that of the missing
24
root structures of the teeth replaced with a bridge, is used in bridgework design.
This law remains controversial in terms of supporting clinical evidence.[Bartlett D,
Ricketts D,2013] Crown to root proportion is the distance from the occlusal/incisal
surface of the tooth to the alveolar crest in relation to the length of root within
the bone. The minimum ratio of crown to root is considered to be 1:1, although
the most favorable is a crown: root of 2:3. As the proportion of tooth reinforced
by bone reductions, the lever effect rises. [ Shillingburg et al.,2014]
Root configuration should be measured when choosing abutment(s). Divergent

roots of posteriors offer better support compared to converging, fused or conical
roots. Roots that curve apically offer increased maintenance compared to those
which have a fixed taper. [ Shillingburg et al.,2014]
The number of abutments required depends on both the location of the tooth to
be taked a place and the length of the span. Cantilever designs utilizing one
abutment is the design of choice for replacing a single tooth anteriorly and can
also be used posteriorly.[Planning and Making Crowns and Bridges, Fourth
Edition,2006]
Occlusion of the pontic with the opposite tooth should be assessed. This may
decide which type of design is most appropriate and therefore how many
abutments are required. For resin bonded bridges the pontic should have light
contact in intercuspal position (ICP) and no contact in lateral excursion. [Ibbetson
R et al,2017][ Shillingburg et al.,2014]
2.6Biomechanical Considerations:
Torquing load can happen when the pontic lies external to the interabutment axis
line as the pontic performances as a lever arm. This is specially valid to long span
bridges replacing multiple anteriors. [Shillingburg et al.,2014] Deflection varies
openly with the cube of the length, and inversely with the cube of the
occlusogingival thickness of the pontic. The longer the span, the more deflection
occurs. The amount of deflection is 8 times greater when the length of the span
rises to 2 pontics, and rises to 27 times more with 3 pontics in comparison to a
25
single pontic. It is likely that improved span length will outcome in the abutments
being subjected to enlarge torquing load. In the thinner the pontic, the extra
deflection occurs. If the thickness of the pontic is diminished by 50% this causes
an 8 times rise in deflection. Choosing pontics with increased occlusogingival
dimension and using high yield strength alloys to construct the prosthesis will
help reduce deflection. [Shillingburg et al., 2014]
2.7Types of artificial plastic teeth:

Types of artificial plastic teeth (known in the trade as Pontics)
1) Wash-through Pontic [Gopakumar A, Boyle EL,2013] (also known as hygienic

pontic or sanitary pontic).[Planning and Making Crowns and Bridges, Fourth
2) Dome Pontic (also known as bullet or torpedo shaped). [ Gopakumar A, Boyle

EL,2013]
3) Ridge Lap Pontic (also known as Full Saddle Pontic). [ Gopakumar A, Boyle
EL,2013]
4) Modified Ridge-Lap Pontic. [Gopakumar A, Boyle EL, 2013]
5) Ovate Ponti. [Gopakumar A, Boyle EL , 2013]A bridge too far’—the negative

impact of a bridge prosthesis on gingival health and its conservative management
26
2.8 A pontic aims: [Planning and Making Crowns and Bridges, Fourth Edition, CRC
Press, 2006]
To restore aesthetics, give occlusal stability and improve function
1-The hygienic pontic: does not contact the underlying alveolar ridge, making it
the most forthright to keep hygienic or clean. Due to the less aesthetics of this
design it is most usually active to replace mandibular molars.
2-The bullet pontic is the second most favorable in terms of being able to
maintain good oral clearance, with the pontic only contacting one point of the
alveolar ridge.
3-Ridge lap and modified ridge lap pontics have greater aesthetics to the designs
debated before, with the labial/buccal surface aiming to reestablish the form of a
natural tooth from the incisal edge to the gingival margin. To diminish coverage of
the soft tissues the lingual/palatal portion of the pontic is reduced to develop
accessibility for keeping good oral hygien or oral clearance
4- The modified ridge lap design the pontic just attach the buccal side of the
alveolar bone.
5-The ovate pontic: attach with the underlying soft tissue and cover the defects of
the edentulous ridge with applying light pressure.[ Reddy K et al.,2009] It is
commonly used in provisional bridges following extraction of teeth to improve
the immediate profile and helps in shaping the gingiva around the future fixed
prosthesis.
27
2.9Types of bridges according to durability:
Bridges can either be provisional (temporary / interim) or permanent. The
provisional bridge is a intermediate restoration that keeps the teeth that are
deteriorated by the preparation, and stabilizes the dental tissues till the
fabrication of the final restoration, moreover, it can pave the way to the
aesthetics of the future permanent restoration and its form, which can help the
patient accept the final profile.[ Rosenstiel SF et al.,2006] Provisional restorations
are designed to be utilized for only a few weeks to months, they can be fabricated
directly (by chair side), or indirectly ( in the dental laboratory)which take time. It
is usually tried in a few times to checked if it fitting properly and if its margins are
well adjusting on the teeth surface and gingiva, it may need relining or a few
adaptation.[ Smith BG ,1998] Provisional bridges can either be made of acrylic
resins or metal. The resins are the most commonly used; they are either made of
cellulose acetate, polycarbonate or poly-methyl methacrylate. Other chemically
activated resins include poly-R methacrylate’s: these are methacrylate’s with
ethyl or isobutyl substances added to rise the strength of material. Also,
commonly used resins include the BisGMA based dimethacrylate, and the visible
light urethane di-methylacrylate.[ Smith BG ,1998][ Nallaswamy D ,2003]
Dimethacrylate-based materials were found to be better than
monomethacrylates for temporary restorations in terms of flexural strength and
rigidity.[ Kim SH,2018][ Astudillo-Rubio D et al., 2018]
28
2.10Types of bridges according to material:
1) Metal based, noble based metals such as gold, or base metal alloys such as
nickle chromium.
2) Non-metal based. They can be either resin veneered, fiber-reinforced

composite, porcelain fused to metal, or ceramics which are either silica, alumina,
or zirconia. [Rosenstiel SF et al., 2006]
Acrylic resin and porcelain fused to metal (PFM) : Acrylic resin was the first
veneering material used to support reestablish the aesthetics of crown and
bridges, the aim was to maintain a similar shade to natural teeth by cementing it
on the labial surface of metal crown / bridges, however, resin veneered dental
prosthetics less stability and abrasion resistance.[ Rosenstiel SF et al.,2006]
Porcelain fused to metal (PFM) was then introduced; the porcelain is consist of
two layers (one opaque to cover the metal substructure and another translucent
to afford an enamel illusion). Still several researchers consider PFM the gold
standard as it has been reported to have 95% success over a 10-year period, a
reason why newer sorts of all-ceramic restorations are usually compared to PFM
crowns / bridges to assess its success and durability.[Ahmad I,2012] However,
PFM restorations may show a grey color at the cervical margins of the tooth
showing the metal substructure.
IPs Emax : IPs Emax ceramics offer great aesthetic properties, that's why its use
has been progressively in popular, however, there's insufficient proof to
determine the longevity of Emax in bridges; some reports found fair short-term
existence, but unfavorable medium-term survival. Failures of repairs were most
reported in the posterior teeth region. IPs Emax is available as press ingots or as
IPs Emax CAD-CAM system.[ Willard A,2018] Emax use in crowns or bridges is not
recommended for patients who suffer from bruxism.[ Magne P, 2000]
Zirconia
Zirconia is used in anteriorregion, and posterior region fixed bridges, also on

implants. Zirconia is fabricated using the dental CAD-CAM technology.[ Manicone
PF, 2007] It has high mechanical power and it can resist great occlusal load
29
compared to all ceramic materials.[ Daou EE 2014] in addition it can resist crack
spread in the core material, however, cracks often occur in the veneering material
leading to its break whether in the tooth maintenance or implant-supported
bridges.[ Le M et al., 2015][ Larsson C,2011] Reports found that the 3×3 mm
designed connectors in zirconia bridges increased the strength to resist fracture
by 20%.[ Bahat Z,2009] Although the use of ceramic based fixed prosthesis have
been popular as it achieves a lifelike, highly esthetic appearance, a Cochrane
review found insufficient evidence to support or refute the effectiveness of
ceramic materials for fixed prosthodontics treatment over metal-ceramic.[ Poggio
CE, 2017]
2.11Clinical stages of bridgework

1. Assessment: Clinical assessment of the patient's fitness for bridgework.
Detailed history including medical history (appropriate assessment of the
appropriateness of the patient's oral environment (including occlusion, caries
hazard, periodontal risk, radiographic examination, sensibility testing),
assessment of patient goals & motivation, abutment tooth selection and bridge
design.[Ibbetson R et al.,2017)][ Planning and Making Crowns and Bridges, Fourth
2. Primary impressions: Primary impressions might be taken with alginate to make

study casts. A facebow record should also be taken to allow the occlusion to be
planned previous to provision of the prosthesis. [Shillingburg et al., 2017]
3. Diagnostic wax up: This enables the patient to visualise how the definitive
prosthesis will look. The wax up can also be used to construct a putty matrix
which can be used subsequently to make a temporary restoration.[ Ibbetson Ret
al., 2017]
4. Restoration replacement: Restorations in abutment teeth with questionable

prognosis or old composite resin restorations for adhesive bridgework should be
exchanged.[Shillingburg et al.,2014]
30
5. Tooth preparation: This should be completed with reference to radiographs
and study casts obtained during treatment planning. For conventional bridges,
tooth preparation should aim to conserve tooth tissue, confirm a parallel path of
insertion, achieve clearance in the occlusion and ensure well defined preparation
margins. [ Ibbetson Ret al., 2017] The taper of each preparation on the abutment
teeth must be the similar. This is known as parallelism amongst the abutments
and permits the bridge to fitting onto the abutment teeth. Adhesive bridges
require minimal preparation.
6. Master impressions: A precise impression should be made of the prepared

teeth, along with an impression of the opposing arch. The master casts are used
to provide accurate information about the occlusion to the laboratory and
construct the prosthesis. [ Ibbetson R et al.,2017]
7. Occlusal registration: An occlusal registration is required when providing broad

bridgework to permit the opposing casts to be related accurately. This may not be
necessary if only a minor number of teeth are to be reestablished. [ Ibbetson Ret
al., 2017]
8. Temporary restoration: Temporary restorations should be fabricated if

probable to keep and preserve the prepared teeth until employment of the final
restoration. [ Ibbetson R et al., 2017]
9. Try in: Confirm the clinical satisfactoriness before cementing definitively. Assess
the prosthesis on the master casts and recognize the cause of any problems if
present. A period of temporary cementation to judge clinical acceptability
previous to definitive placement is sometimes utilized.[ Ibbetson R et al., 2017]
10. Final placement: Once satisfied the prosthesis is clinically suitable, cement and
bond the bridgework definitively.[ Ibbetson R et al., 2017]
11. Review: Assess the bridgework and manage any post-operative matters.[
Ibbetson R et al.,2017]
31
2.12Restoration fabrication
As with single-unit crowns, bridges may be fabricated by the lost-wax method if
the re-establishment is to be either a multiple-unit of PFM. Another fabrication
technique is to use CAD/CAM software to machine the bridge. There are especial
thoughts when preparing for a multiple-unit restoration in that the association
between the two or more abutments must be kept in the restoration. That is,
there must be suitable parallelism for the bridge to seat correctly on the margins.
Occasionally, the bridge does not seat, but the dentist is unsure whether it is
because the spatial relationship between the abutments is improper, or whether
the abutments do not really fitting the preparations. The only way to define this is
to section the bridge and try in each abutment by itself. If they each fit
individually, the spatial relationship was incorrect, and the abutment that was
sectioned from the pontic must be re-attached to the pontic according to the
newly confirmed spatial relationship. This is accomplished with a solder index.
The proximal surfaces of the sectioned units (that is, the adjacent surfaces of the
metal at the cut) are roughened and the relationship is conserved with a material
that will hold on to both sides, such as GIC pattern resin. With the two bridge
abutments separately placed on their prepared abutment teeth, the resin is
applied to the location of the sectioning to re-establish a proper spatial
relationship between the two pieces. This can then be referred to the laboratory
where the two pieces will be soldered and resumed for another try-in or final
cementation.
32
2.13Bridge failures
Common causes for bridge failures:
1. Poor oral hygiene: As with any fixed dental prosthesis containing bridges,
keeping good oral hygiene to avoid plaque formation around the bridge is crucial.
This will confirm prolonged presentation. A study examined the gingival health
round the fixed bridges afterwards a 14-day - 6 month post insertion discovered
that the surfaces were more plaque retaining, producing gingival inflammation
regardless the material of fabrication of the bridge, unlike single crowns which
didn't show the same effect.[ Kc Basnyat S et al., 2015][ Ortolan SM et al.,2012]
2. Mechanical failures: These disasters can occur due to loss of retention of the
bridge due to incorrect cementation, building or preparation.[ Mitchell L et
al.,2014][ Hargreaves K, Berman L ,2010]
Fracture of the metal coating or pontic can also main cause to mechanical
failures. Fracture in connectors of bridges at the gingival side is a communal
finding in greatest all-ceramic bridges. [ Plengsombut K et al.,March 2009]
3. Biological failures: These can happen due to caries in the tooth (one of the
communal reasons of crown and bridge failures[Briggs Pet al.,2012] or due to
pulpal harm. Problems with abutment teeth such as tooth fracture, secondary
caries or periodontal disease can produce distress and place pressure on
surrounding soft tissues to also cause a biological failure of the bridge.
4. Aesthetic failures: These can happen at the time of cementation and include;
color mismatch, irregularity of margins or inadequate tooth contour.
Aesthetics failures can also happen during a period of time including through
wear of teeth, gingival recession or drifting of teeth. [Mitchell L et al., 2014]
33
2.14Problems with abutment teeth: Abutment teeth affected by secondary
caries, vitality loss or periodontal illness may all cause bridge failure. [ Mitchell L
et al.,2014]
2.14.1Periodontal disease:
Periodontal disease may be generalized, or in an ineffectively planned, made or
maintained restoration it is encouraging may be accelerated locally. On the off
chance that the loss of periodontal attachment is diagnosed sufficiently early and
the cause expelled, no further treatment is usually necessary. Be that as it may if
the disease has advanced to the point where the visualization of the tooth is
significantly decreased when the crown or bridge, or the tooth itself, may have to
be expelled. With a bridge, the original indication will, in any case, be available,
and so something should be done to replace the missing teeth. It may be
imagined to make a larger bridge, or the abutment teeth may be decreased and
utilized as abutments for an over-denture. Teeth that have lost so much help that
they are not suitable as bridge abutments are also not suitable either as
abutments for conventional partial dentures. [ Bernard GN Smith et al.,2007 ]
2.14.2Problem with the pulp:

Unfortunately, in spite of taking the usual precautions amid tooth preparation,
abutment teeth may progress toward becoming non-vital after a crown or bridge
has been established. It is usually reasonable to attempt endodontic treatment by
making an access cavity through the crown. There are obviously issues in the
application of a rubber dam with bridges, although these can usually be
overwhelmed by punching a large opening and applying the rubber dam just to
one tooth, extending the rubber over the connectors. It is hard to gain access to
the pulp chamber and expel the coronal pulp totally without enlarging the access
cavity to a point where the remaining tooth preparation turns out to be
excessively slender and weak to help the crown satisfactorily, or where the (pin)
maintenance of a point is damaged. The crown may have been made with rather
unique anatomy from the natural crown of the tooth for esthetics or occlusal
reasons so the angulation of the root is not immediately apparent. Given that
these pulps can be survived and a satisfactory root filling placed, the forecast of
34
the crown or bridge is just marginally decreased. Teeth that were already
satisfactorily root-filled when the crown or bridge was made may later give
inconvenience. It may be conceivable to re-root fill the tooth through the crown,
yet apicectomy is an alternative arrangement. Care must be taken not to
abbreviate the foundation of an abutment tooth more than is absolutely
necessary with the goal that the maximum support for the bridge can be
maintained. .[ Bernard GN Smith et al.,2007 ]
2.14.3Caries:
Secondary caries happening at the margins of crowns or bridge retainers usually
means that the patient has changed his or her eating routine, the standard of oral
cleanliness has lapsed or there is some inadequacy in the restoration that is
encouraging the formation of plaque. The cause of the problem ought to be
distinguished and dealt with before repair or replacement is started.[ Bernard GN
Smith et al.,2007 ]
2.14.4Fracture of the prepared natural crown or root:

Fractures of the tooth occasionally happen because of trauma, and some of the
time not withstanding amid normal capacity, although the crown or bridge has
been available for quite a while. With a bridge abutment, it is usually necessary to
remove the bridge, however occasionally the abutment tooth can be abstained
from and the root evacuated surgically, the tissue surface of the retainer being
repaired and changed over into a pontic. [ Bernard GN Smith et al.,2007 ]
2.14.5Movement of the tooth:

Occlusal trauma, periodontal disease or relapsing orthodontic treatment may
result in the delegated tooth or bridge abutment ending up free, drifting, or both.
35
At the point when the cause is periodontal disease or relapsing orthodontic
treatment, this must be cured before the crown or bridge is remade. [ Bernard GN
Smith et al.,2007 ]
2.15Design Failures:
2.15.1Inadequate bridge design:
Designing bridges is troublesome. It is neither an exact science nor creative art. It
needs learning, background and judgment, which take years to accumulate. So it
is not amazing that a few plans of the bridge, despite the fact that benevolent and
honestly executed, fail. A straightforward classification of these failures is as
'under-prescribed ' and 'over-prescribed' bridges. [ Bernard GN Smith et al.,2007 ]
2.15.2Under-prescribed bridges:
These incorporate structures that are unstable or have too couple of abutment
teeth – for example a cantilever bridge carrying pontics that spread too long a
span or a fixed– movable bridge where again the span is excessively long, or
where abutment teeth with too little support have been
Chosen. Another 'under-design' fault is to be excessively conservative in choosing

retainers, for example, intracoronal inlays for fixed-fixed bridges. With these
structure faults little can be done other than to evacuate the bridge and replace it
with another plan.[ Bernard GN Smith et al.,2007 ]
2.15.3Over-prescribed bridges:
Cautious dental specialists will some of the time incorporate greater abutment
teeth that are necessary, and fate usually dictates that it is the unnecessary
retainer that fails. The main lower premolar may be incorporated as well as the
second premolar and the second molar in a bridge to replace the lower first
molar, no uncertainty so that there will be equal quantities of roots each finish of
36
the bridge in order to consent to the redundant 'Ante's Law'. This is not
necessary. Another example is to utilize the upper canines and both first
premolars on each side in replacing the four incisor teeth. As well as being
ruinous, these offers ascend to unnecessary practical troubles in making the
bridge and cleaning it. This, thusly, diminishes the chances of the bridge being
effective. At the point when an unnecessarily large number of abutment teeth
have been incorporated into a bridge and one of the retainers fails, it is in some
cases conceivable to the area the bridge in the mouth and remove the failed unit,
leaving the remainder of the bridge to proceed in capacity. The failed unit is
remade as an individual restoration. The retainers themselves may be
overprescribed, with complete crowns being utilized where partial crowns or
intracoronal retainers would have been very adequate; or metal-ceramic crowns
may be utilized where all-metal crowns would have been adequate. At the point
when the pulp dies in such a case, it is intriguing to speculate whether this
probably will not have happened with a less drastic decrease of the crown of the
natural tooth. [ Bernard GN Smith et al.,2007 ]
37
2.16 Marginal insufficiencies:
2.16.1Positive ledge (overhang):
A positive ledge is an overabundance of crown material projecting past the
margin of the preparation. Taking into account that this is a fairly easy fault to
perceive and correct before the crown or bridge is fitted, it is astonishing how as
often as possible overhangs are experienced. Be that as it may, usually
conceivable to correct them without generally exasperating the restoration. [
Bernard GN Smith et al.,2007 ]
2.16.2Negative ledge:
This is an inadequacy of crown material that leaves the margin of the preparation
uncovered yet with no major gaps between the crown and the tooth. Again it is a
fairly basic fault, particularly with metal margins, however one that is
troublesome or difficult to correct at the attempt in a stage. It regularly arises
because the impression did not give a clear enough indication of the margin of
the preparation and the die was over-trimmed, bringing about under-expansion
of the retainer Gave that the crown margin is supragingival or exactly at the
gingival margin, it is here and there conceivable to adjust and clean the tooth
surface. At the point when the ledge is subgingival, and particularly when there is
localized gingival inflammation associated with it, it may, in any case, be
conceivable to adjust the ledge with a pointed stone or bur, although this will
cause gingival damage. Nonetheless, it is usually necessary to remove the crown
or bridge.[ Bernard GN Smith et al.,2007 ]
38
2.16.3Defect:
A defect is a gap between the crown and preparation margins. There are four
potential causes:
1. The crown or retainer did not fit and the gap was available at try-in
2. The crown or retainer fitted at try-in yet at the season of cementation the
hydrostatic pressure of the bond (particularly if the cement was starting to set)
delivered fragmented Seating.
3. With a portable bridge or brace abutment, the cement discouraged the

versatile tooth in it attachment more than the other abutment teeth, in this
manner leaving the gap
4. No gap was available at the season of cementation, yet one created following
the loss of cement at the margin and a crevice has been created by a combination
of erosion/abrasion and potentially caries. In any of these cases, the decision is to
evacuate the bridge, reestablish the gap with a suitable restoration, or leave it
alone and watch it periodically. Perfectionists may say that all damaged retainers
ought to be expelled and replaced. Be that as it may, this isn't always in the
patient's best advantage, and the skillful application of marginal repairs may
expand the life of the restoration for a long time. [ Bernard GN Smith et al.,2007 ]
2.16.4Poor shape or shading :

More can be done to adjust the shape of a crown or bridge in situ than to change
its shading, although occasionally surface stain on porcelain can be removed and
the porcelain cleaned. The shape of metal-ceramic crowns or bridges can be
adjusted on the off chance that they are excessively cumbersome (and this is
usually the issue), gave that it is done gradually. At the principal indication of the
opaque layer of porcelain, the adjustment is halted. Effective modifications can
regularly be made to open cramped embrasure spaces, diminish over the top
cervical bulbosity, abbreviate retainers and pontics, and obviously adjust the
blocking surface. In all cases, the adjusted surface, regardless of whether it is
metal or porcelain, ought to be cleaned.[ Bernard GN Smith et al.,2007 ]
39
2.16.5Occlusal problem:
As well as creating abutment tooth mobility faults in the occlusion damage to the
retainers and pontics by wear and fracture. The occlusion change because of the
extraction of other teeth, or their restoration, or through wear on the occlusal
surface.[ Bernard GN Smith et al.,2007 ]
2.17Oral manifestations of bridge failures:

Bridge failures effect in clinical problems and patients can exist with:
1. Pain in the oral cavity
2. Sensitivity, bleeding and inflammation of the gums [Mitchell L et al., 2014]
3. Foul breath and taste disturbances.
Management of bridge failures depend upon the extent and type of failure and
these can be prevented through forming a thorough treatment plan with the
patient as well regularly emphasizing the importance of maintaining a very good
level of oral hygiene after the bridge has been placed. The importance of cleaning
underneath the pontic, through the use of interdental cleaning aids, should also
be reinforced as plaque control around fixed restorations is more difficult. [Briggs
P et al., 2012]
40
2.18Management options include:
1. Keeping the bridge under observation.
2. Repairing, replacing or removing the fault [Briggs P et al., 2012]
2.19Ferrule effect on preparation:

The single greatest significant concern when restoring with a crown is,
undeniably, the incorporation of the ferrule effect. As with the bristles of a
broom, which are grasped by a ferrule when connected to the broomstick, the
crown should enclose a certain height of tooth structure to correctly keep the
tooth from fracture after being prepared for a crown. This has been recognized
through multiple trials as a mandatory continuous circumferential height of 2
mm; any less provides for a significantly advanced failure rate of endodontically-
treated crown-restored teeth. When a tooth is not endodontically treated, the
residual tooth structure will invariably provide the 2-mm height necessary for a
ferrule, but endodontically treated teeth are disreputably decayed and are often
missing significant solid tooth structure. Contrary to popular belief,
endodontically treated teeth are not brittle after being devitalized according to
the following study -CM Sedglay & Messer 1992 Journal of Endodontics. Opposing
to what some dentists trust, a bevel is not at all suitable for implementing the
ferrule effect, and beveled tooth structure may not be comprised in the 2 mm of
required tooth structure for a ferrule.
41
2.20Previous study:
The long- term prognosis fixed dental prosthesis (FDP) with an abutment that has
seriously decreased periodontal support relies upon the support of a healthy
periodontium. Despite the fact that the after final result of this review are
restricted by the amount and nature of included articles, there has all the
earmarks of being no logical proof requiring that in fixed dental prosthesis (FDP)
design, "total periodontal area of abutment teeth should be equal or more than
the total area of tooth or teeth that should be replaced''(Ante's law).In grown-up
patients who have a fixed dental prosthesis (FDP) that has healthy periodontal
tissue support, would abutment that have seriously diminished periodontal tissue
support (that is, those not fulfilling Ante's law1), contrasted and projections that
have no or negligibly decreased periodontal tissue support (that is, those
wonderful Ante's law), lead to bring down FDP survival rates. The reviewer
searched one electronic database (PubMed) through September 2006 and hand
looked seven applicable diaries. They considered just prospective and
retrospective cohort studies distributed in the English language. They
incorporated into the survey just investigations of FDPs with abutment teeth that
did not meet the necessities of Ante's law, as indicated by clinical and
radiographic information. The essential results the analysts estimated and
determined were the five-and 10-year survival rates of these FDPs. They at that
point contrasted the results and distributed survival rates of FDPs that had
projection teeth fulfilling Ante's law.
Six retrospectives met the consideration criteria. A meta-investigation

consolidating the aftereffects of just two examinations (84 members at
baseline[with 17 dropouts] and 79 FDPs) yielded an expected FDP survival rate of
96.4 percent (95 p per cent confidence interval [CI], 94.6– 97.6 per cent) following
five years and 92.9 per cent (95 per cent CI, 89.5– 95.3 per cent) following 10
years. These outcomes were practically identical with distributed survival rates of
FDPs with an abutment that gratified Ante's law.
Ante’s law expresses that "total periodontal area of abutment teeth should be
equal or more than tooth or teeth that should be replaced "For over 80 years, this
law has been educated in standard course readings of prosthodontics as a
42
significant condition affecting FDP design. If Ante's law has appeared at being
proof based, at that point the alternative of an FDP upheld by abutment with
sound however traded off periodontal bone support would be practical for
patients and clinicians to consider. The writers of this audit looked to respond to a
well-engaged inquiry and gave a total depiction of the criteria used to incorporate
and avoid articles. Be that as it may, the audit is constrained by the writers' choice
to seek just a single database and to incorporate just English-language articles.
Additionally, they directed no appraisal of determination understanding between
two free commentators (as it were, they have given no κ statistics). The
discoveries of the six retrospective study included are very much summarized, yet
the discourse is missing with respect to the danger of predisposition or of
heterogeneity among the studies. For instance, it is obscure whether the authors
were predictable in applying to all the included investigations the criteria used to
decide if an FDP fulfilled Ante's law. The absence of consistency between studies
took into consideration just two examinations to be incorporated into the meta-
analysis. Additionally, the author did not survey the potential danger of
production inclination in their review. The six included investigations were of the
lower-quality retrospective design. Besides, the author could not locate a single
clinical examination in which the agents looked at the survival rates between
FDPs that did not meet the necessities of Ante's law and those that did.
Subsequently, this left the author to make correlations between the
consequences of investigations of each individual FDP design. By and by, the
consequences of all checked on studies seemed to exhibit reliably that FDPs set
on seriously compromised periodontally support abutment was workable. Just
two investigations, which included just 79 FDPs and had a high in general member
dropout rate (20 per cent), were qualified for meta-analysis. In any case, the
assessed five-and 10-year survival rates of 96 and 92 percent, individually, are
somewhat higher than the 10-year survival rate of 89.1 per cent (95 per cent CI,
81– 93.8 percent) announced in Tan and colleagues'4 precise survey of FDPs that
included abutment with by and large great periodontal support. Lulic and
colleagues clarified the slight distinction as conceivably being brought about by
administrator inclination in light of the fact that their own review included FDPs in
patients who were dealt with and whose FDPs were kept up normally by clinical
43
experts, as opposed to those in the audit by Tan and colleagues,4 which included
FDPs finished by general dental specialists and dental understudies. Likewise, Tan
and associates' meta-analysis comprised of 2,881 FDPs, contrasted and just 79 in
this review. Be that as it may, agents in two examinations that were distributed
after this review and that met its consideration criteria likewise affirmed the
amazing long term anticipation of FDPs that were supported by periodontally
healthy tissue however that had compromised off bone-support abutment.
[Cabanilla et al.,2009][ Bragger et al., 2011]
With well-kept up, healthy periodontal tissue support, FDPs not fulfilling Ante's
law have survival rates equivalent with the high rates of FDPs that do fulfill Ante's
law. Accordingly, the plan of a FDP does not really need to fulfill Ante's law.
44
Chapter Three:
Materials And Methods

In the present work, the study samples were collected randomly from
patients who had bridge and attended to diagnosis and oral radiology
department in college of dentistry of Tishik International University, in
Erbil during the period between October 2017-March 2018.The
collection of the samples have been arranged according to
questionnaires ,two age group which were between (20-39) and (40-60)
which has been made (figure 7 and 8 ) which include personal
information related to name patient ,gender, and number of missing
tooth or teeth that replaced by dental bridge in posterior region and
location of bridge. The radiographs were taken by the orthopantogram
(figure 1) in diagnosis and oral radiology department and after that by
using New Tom program (figure2) measurement of bone resorption
between CEJ to crest of alveolar bone had been measured for bridge
side and non-bridge side (figure6), after that printed out and bounded
with our questioners and all X-ray evaluated by three examiner and
mean of measurement for each X-ray was recorded and using SPSS
program for data analysis.
45
3.1 Materails
1-orthopantogram: NEWTOM
Plant: VIA BI COCCA 14/C-40026 IMOLA (BO) ITALY
CEPH ARM NEWTOM GIANO
90kvp/10mA max
Focal spot: 0.5mm.
Total filtration: 85kvp
2D mode 3.2mmAL- CBCT 6.2mmAl
Figure 1:orthopantogram:new tom.
46
2-using new tom program for measurement and collection data:
Figure 2:NEWTOM programm.
3-OPG of patients with bridge present:
Figure 3:orthopantogram.
47
4-measaurment of bridge side and non bridge side:
Figure 4:measurment arrow.
Figure 5:measurment of bridge site.
48
Figure 6:measurment of bridge side and non bridge side
49
5-questionary:
2018-2019
Age group (20-39)

Bone resorption comparison in bridge side and non-bridge side
on OPG
In this case sheet used for research about compression of rate of bone resorption
in bridge side and non- bridge side no OPG in patients which are between (20-39)
of age and dental bridge located in posterior area.
Patients name
age
gender
Missing unit
Location of dental bridge
Figure 7:questionary accoridng to age (20-39)
50
2018-2019
Age group (40-60)

Bone resorption comparison in bridge side and non-bridge
Side on OPG
In this case sheet used for research about compression of rate of bone
resorption in bridge side and non- bridge side no OPG in patients which
are between (40-60) of age and dental bridge located in posterior area.
Patients name
age
gender
Missing unit
Location of dental bridge
Figure 8:questionary according to age (40-60)
51
Chapter four:
Results
The data of Table 1 indicate that 55.2% of participants in the study were female and 44.8% of
them were male. Majority (83.8%) of patients were from the age group of 40-60 years. Most of
the participants (65.6%) had one missing unit and were located in the upper jaw, while most of
the non-bridge sites were in the lower jaw.
Table 1: Descriptive data of participants related to their sex, age, missing units, and site of
bridge and non-bridge.
Variable Categories Number Percent

Male 108 44.8
Sex Female 133 55.2
Age groups (years) 20-39 39 16.2
40-60 202 83.8
Missing unit One 158 65.6
Two 83 34.4
Upper right 72 29.9
Upper left 74 30.7
Bridge site
Lower left 35 14.5
Lower right 60 24.9
Non-bridge site Upper right 52 21.6
Upper left 30 12.4
Lower left 96 39.8
Lower right 63 26.1
Total 421 100
Table 1:Descriptive data of participant among bridge and non-bridge site
According to results of Table 2, there was a statistically significant difference in bone resorption
between bridge and non-bridge sides. The average bone resorption of bridge was 3.15 mm which
is lower than that of non-bridge side (3.80 mm). T-test was done to compare between the two
side and P-value was 0.001.
52
Bone resorption (mm) N Mean Std. Deviation P-value T-test
Bridge side 241 3.15 0.94 0.001 Significant
Non-bridge side 241 3.80 1.24
Table 2: Comparison of bone resorption between bridge and non-bridge sides.
4 3.8
3.5
3.15
3
2.5
2 Bridge side
Non-bridge side
1.5 1.24
0.94
1
0.5
0
Mean Std. Deviation
Figure 9:bone resorption between bridge side and non bridge side
The findings of Tables 3 and 4 reveal that the mean bone resorption of bridge side was
lower than that of non-bridge side for both male and female patients.
53
Table 3:Bone resorption of bridge and non-bridge sides for male patients.
3.92
4 3.52
3.5
2.5 Bridge side bone

resorption
2
Non-bridge side bone
1.5 1.2 resorption
0.99
1
0.5
0
Mean Std. Deviation
Figure 10:rate of bone resorption in male patient

Table 4:Bone resorption of bridge and non-bridge sides for male patients.
54
4 3.7
3.5
2.85
3
2.5
2 Mean
1.26
1.5 Std. Deviation
0.78
1
0.5
0
Bridge side Non-bridge side
bone bone
resorption resorption
Figure 11:rate of bone resorption in female patient
The data from Table 5 show that there was no statistically significant difference between both
age groups in bridge sides and P-value was 0.73. In contrary the difference was significant and
the age group 40-60 years had higher bone resorption (mm3.91) compared to 20-39 years age
group who had mean bone resorption of 3.19 mm. P-value was 0.001.
Side
Age (years) N Mean Std. Deviation P-value T-test
Bridge 20-39 39 3.20 1.09 0.73 Non- significant
40-60 202 3.14 0.91
Non-bridge 20-39 39 3.19 0.97 0.001 Significant
40-60 202 3.91 1.25
Table 5:: Difference in bone resorption of bridge and non-bridge sides according
to age groups of the patients.
55
3.2 3.14
3.5
2.5
2 20-39
1.09 40-60
1.5 0.91
1
0.5
0
Mean Std. Deviation
Figure 12:rate of bone resorption in bridge site
4.5
3.91
4
3.5 3.19
3
2.5
20-39
2
40-60
1.5 1.25
0.97
1
0.5
0
Mean Std. Deviation
Figure 13:rate of bone resorption in non-bridge site
The findings of Table 6 point to very close average bone resorption of both one and two missing
units whether in bridge or non-bridge sides. T-tests were done to find out the difference and P-
values were more than 0.05.
56
Side Missing units N Mean Std. Deviation P-value T-test
Bridge One 158 3.10 0.92 0.23 Non- significant
Two 83 3.25 0.97
Non-bridge One 158 3.75 1.28 0.39 Non- significant
Two 83 3.89 1.15
Table 6:: Difference in bone resorption of bridge and non-bridge sides according
to age groups of the patients.
The findings of Tables 7 and 8 reveal that there was no statistically significant difference in
mean bone resorption of upper and lower jaws in both bridge and non-bridge sides.
Bridge site N Mean Std. Deviation P-value T-test

Upper jaw 146 3.14 0.97 0.76 Non- significant
Lower jaw 95 3.18 0.90
Table 7:Comparison of bone resorption in upper and lower jaws among bridge site.
R
3.5
3.14 3.18
3
2.5
2
Upper jaw
1.5 Lower jaw
0.97 0.9
1
0.5
0
Mean Std. Deviation
Figure 14:rate of bone resorption between each jaw in bridge site
57
Non-bridge site N Mean Std. Deviation P-value T-test
Upper jaw 82 3.72 1.30 0.48 Non- significant
Lower jaw 159 3.84 1.21
Table 8: Comparison of bone resorption in upper and lower jaws among bridge site.
3.72 3.84
4
3.5
3
2.5
Upper jaw
2 1.3 Lower jaw
1.21
1.5
1
0.5
0
Mean Std. Deviation
Figure 15:rate of bone resorption bewtween each jaw in non bridge side
Figure 16:distribution of case according to sex.
58
Data management and statistical analysis: Data will be recorded on a specially
designed questionnaire, collected and entered in the computer and then analyzed
using appropriate data system which is called Statistical Package for Social
Sciences (SPSS) version 24 and the results will be compared between patients with
different variables, with a statistical significance level of < 0.05. The results will be
presented as rates, ratio, frequencies, percentages in tables and figures and
analyzed using T-test.
59
Chapter five:
Discussion
This study concentrate rate of bone resorption in bridge site and non-
bridge site in posterior areas at TIU dental school.
5.1 descriptive statistics:

In this study 242 cases about posterior fixed dental bridge have been
recorded from total number of cases which have been done there were
44.8% of participants were male and 55.2% female, according to two
age group which were between (20-39)and percentage of participants
were 16.2% and another age group was (40-60) and percentage of
participant were 83.8% -according to missing unit – percentage of
missing unit was 65.6%, two missing unit were 34.4% -according to site
of bridge , upper right 29.9%, upper left 30.7% , lower left 14.5 % lower
right 24.9%- according to non-bridge site , upper right 21.6% upper left
12.4%, lower right 26.1%.
60
5.2 inferential statistics:
comparison of bone resorption
- Comparison of bone resorption between bridge and non-bridge side:
According to results , there was a statistically significant differences in

bone resorption between bridge and non-bridge sides the average of
bone resorption of bridge was 3.15mm which is lower than of non-
bridge site(3.80mm) T-Test was done to compare between two site ,
and P-value was 0.001.
-Bone resorption of bridge and non-bridge side for male patients:

bone resorption between bridge side and non-bridge side in male the
average of bone resorption of bridge was (3.52mm) which is lower than
that of non-bridge site(3.92mm) T-Test was done to compare between
tow site and P- Value 0.002.
-Bone resorption of bridge and non-bridge sites female patients:

bone resorption between bridge side and non-bridge side in female
average of bone resorption in bridge site was(2.85mm) which is lower
than that of non-bridge site (3.70mm)T-Test Value done to compare
between two sides and P-value 0.001.
61
-Difference in bone Resorption of bridge and non-bride side according
to age group of the patients:
There was no statistically significant difference between both age

groups in bridge side.
The average of bone resorption in age group (20-39) was (3.20mm)

which was a little bite higher than second age group which were (40-
60) and was (3.14mm) and P-Value was (0.73).
In contrary differences was significance, the age group (40-60) years

had higher bone resorption (3.91mm) compare to (20-39) years age
group had mean bone resorption of (3.19mm) P-value was 0.001.T-test
value done to compare between two sites.
-Difference in bone resorption of bridge side and non-bridge site

according to missing unit:
The findings pointed to very close average bone resorption of both and
tow missing units whether in bridge or non-bridge sides. In bridge side
average of one missing unit is (3.10mm) and in tow missing units (3.25
mm) and T-test done to compare between tow missing units area and
P-value (0.23) which is higher than (0.05).
In non-bridge side the average of one missing unit was (3.75mm) while
the average in tow missing unit was (3.89mm) and also T-test was done
to compare between tow missing area and P-value (0.39) which is more
than (0.05).
62
-Comparison bone resorption in upper and lower jaws among bridge sides:
The findings reveal that there were no statistically significant

differences in mean bone resorption of upper and lower jaws in bridge
side. The average of upper jaw was (3.14mm) while the average of
bone resorption in lower jaw (3.18mm), .T-test value has been done to
compare between tow side-value (0.75).
-Comparison of bone resorption in upper and lower jaws among non-bridge

side:
the finding reveal that there was no statically significant difference in

mean bone resorption of upper and lower jaw in non-bridge side, the
mean of bone resorption in upper jaw was (3.72) well as in lower jaw
(3.84).T-test value have been done to compare between tow site ,P-
value (0.48).
63
5.3 compare to other studies
-Rehmann et al they found that evaluate the long-term outcomes of long-span

fixed dental prostheses (LSFDPs) not meeting Ante's law. They found that the
patient's compliance is a important factor in the successful operation of a
LSFDP, whereas other factors are of minor importance.
-Also they study on 36 patients who had 41 LSFPDs. The average survival time
of the LSFDPs was calculated using the Kaplan-Meier technique. The influence of
the factors (gender, localization, number of abutments, Kennedy Class,
dentition of the opposing jaw) were analyzed (log-rank test and Cox regression;
P < .05).
- The calculated result probability after 3 years was 88.3%, and 57.4% after 5
years. The only significant variance in the average survival time could be found
in LSFDPs with two abutment teeth in comparison with LSFDPs with three and
more abutment teeth. Although all of the patients were invited to an oral
condition and maintenance program frequently, only 13.8% attended.
-The results were taken together with data from the literature, which indicate
that the patient's compliance is an essential cause in the successful application
of a LSFDP, whereas other factors are of minor importance. [Rehmann P et al,
2015].In Tishk International dental clinic, our research that done, actually there
we worked only on single unit and tow unit missing and the result does not
show any significance differences between them.
-Clin Oral Implants Res, they found that The long- term prognosis fixed dental
prosthesis (FDP) with an abutment that has seriously decreased periodontal
support relies upon the support of a healthy periodontium.
- Despite the fact that the after final result of this review are restricted by the
amount and nature of included articles, there has all the earmarks of being no
logical proof requiring that in fixed dental prosthesis (FDP) design, "total
periodontal area of abutment teeth should be equal or more than the total area
of tooth or teeth that should be replaced’’ (Ante's law).
64
-In grown-up patients who have a fixed dental prosthesis (FDP) that has healthy
periodontal tissue support, would abutment that have seriously diminished
periodontal tissue support (that is, those not fulfilling Ante's law1), contrasted
and projections that have no or negligibly decreased periodontal tissue support
(that is, those wonderful Ante's law), lead to bring down FDP survival rates. The
reviewer searched one electronic database (PubMed) through September 2006
and hand looked seven applicable diaries.
-They considered just prospective and retrospective cohort studies distributed

in the English language. They incorporated into the survey just investigations of
FDPs with abutment teeth that did not meet the necessities of Ante's law, as
indicated by clinical and radiographic information. The essential results the
analysts estimated and determined were the five-and 10-year survival rates of
these FDPs. They at that point contrasted the results and distributed survival
rates of FDPs that had projection teeth fulfilling Ante's law.
- Six retrospectives met the consideration criteria. A meta-investigation

consolidating the aftereffects of just two examinations (84 members at
baseline[with 17 dropouts] and 79 FDPs) yielded an expected FDP survival rate
of 96.4 percent (95 p per cent confidence interval [CI], 94.6– 97.6 per cent)
following five years and 92.9 per cent (95 per cent CI, 89.5– 95.3 per cent)
following 10 years. These outcomes were practically identical with distributed
survival rates of FDPs with an abutment that gratified Ante's law.
-Ante's law expresses that "total periodontal area of abutment teeth should be
equal or more than tooth or teeth that should be replaced "For over 80 years,
this law has been educated in standard course readings of prosthodontics as a
significant condition affecting FDP design. If Ante's law has appeared at being
proof based, at that point the alternative of an FDP upheld by abutment with
sound however traded off periodontal bone support would be practical for
patients and clinicians to consider.
The writers of this audit looked to respond to a well-engaged inquiry and gave a
total depiction of the criteria used to incorporate and avoid articles. Be that as it
may, the audit is constrained by the writers' choice to seek just a single
65
database and to incorporate just English-language articles. Additionally, they
directed no appraisal of determination understanding between two free
commentators (as it were, they have given no κ statistics).
- The discoveries of the six retrospective study included are very much
summarized, yet the discourse is missing with respect to the danger of
predisposition or of heterogeneity among the studies. For instance, it is obscure
whether the authors were predictable in applying to all the included
investigations the criteria used to decide if an FDP fulfilled Ante's law. The
absence of consistency between studies took into consideration just two
examinations to be incorporated into the meta-analysis. Additionally, the
author did not survey the potential danger of production inclination in their
review.
-The six included investigations were of the lower-quality retrospective design.

Besides, the author could not locate a single clinical examination in which the
agents looked at the survival rates between FDPs that did not meet the
necessities of Ante's law and those that did. Subsequently, this left the author
to make correlations between the consequences of investigations of each
individual FDP design.
- By and by, the consequences of all checked on studies seemed to exhibit

reliably that FDPs set on seriously compromised periodontally support
abutment was workable. Just two investigations, which included just 79 FDPs
and had a high in general member dropout rate (20 per cent), were qualified for
meta-analysis. In any case, the assessed five-and 10-year survival rates of 96
and 92 percent, individually, are somewhat higher than the 10-year survival rate
of 89.1 per cent (95 per cent CI, 81– 93.8 percent) announced in Tan and
colleagues'4 precise survey of FDPs that included abutment with by and large
great periodontal support. Lulic and colleagues clarified the slight distinction as
conceivably being brought about by administrator inclination in light of the fact
that their own review included FDPs in patients who were dealt with and whose
FDPs were kept up normally by clinical experts, as opposed to those in the audit
66
by Tan and colleagues, 4 which included FDPs finished by general dental
specialists and dental understudies.
- Likewise, Tan and associates' meta-analysis comprised of 2,881 FDPs,

contrasted and just 79 in this review. Be that as it may, agents in two
examinations that were distributed after this review and that met its
consideration criteria likewise affirmed the amazing long term anticipation of
FDPs that were supported by periodontally healthy tissue however that had
compromised off bone-support abutment. [Cabanilla et al.,2009][ Bragger et al.,
2011]
- With well-kept up, healthy periodontal tissue support, FDPs not fulfilling
Ante's law have survival rates equivalent with the high rates of FDPs that do
fulfill Ante's law. Accordingly, the plan of a FDP does not really need to fulfill
Ante's law. According to our study bone resorption in gender will be affected
but will not be affected by location of bridge or age.
67
Chapter six: conclusion and suggestion.
6.1-conclusion
1-comparision of bone resorption between bridge and non-bridge side
is significant.
2-comparision of bone resorption of bridge and non-bridge sides for

male patients is significant.
3-comparision of bone resorption of bridge and non-bridge sides for

female patients is significant.
4-diffrience of bone resorption in bridge side according to age groups is

non-significant.
5-diffrience of bone resorption in non-bridge side according to age

groups is significant.
6-diffrience in bone resorption in bridge side according to missing unit

is non-significant.
7-diffrence in bone resorption in upper and lower jaw among bridge

side is non-significant.
8-diffrence in bone resorption in upper and lower jaws in non-bridge

side is non-significant.
68
6.2 Suggestion:
1- Further studies are needed for investigation effect of oral hygiene around
abutment teeth in fixed bridge.
2- Further studies are need for investigation effect of smoking on rate of

success of dental bridge, and bone resorption.
3- Further studies are need for finding effects of systemic disease on rate of
bone resorption and successful rate of dental bridge
4- Further studies are needs for investigation presence of bridge in anterior

region and comparison of rate of bone resorption with other sites.
5- Further studies are need for investigation, if missing teeth were more than
2 unit and effect of it on rate of bone resorption.
6- Further studies are need for investigation presence of dental implant as

abutment and comparison rate of bone resorption with the tooth supporting
dental bridges.
7- Further studies are need about the materials (metal, ceramic, zircon) that
used for dental bridge and effect of it on bone resorption.
69
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Tishk International University

Bone resorption comparison in bridge side and non-bridge side on

Marwa Latif Fatih

Nakhshin Khalid Hamad

Prof.Dr.Jabbar Husain Kamal

Project submitted in Partial Fulfillment of the

Requirements for the degree of

Bachelor in dental surgery (BDS)

Every challenge work needs self-efforts as

Father & Mother,

Whose affection, love, encouragement and

We would like to thank Dr. Rebaz for statistical analysis.

We want to thank Dr.Rebuar Fadhil for helping us.

Background: Fixed dental bridge, it is fixed prosthetic restoration used to restore

ICP Intercuspal position

PMF Porcelain fused to metal

CAD Computer aided drawing

CAM Computer aided modeling

FDP Fixed dental prosthesis

LSFDPs Long-span fixed dental prosthesis

TMJS Tempromandibular joints

GIC Glass inomer cement

Fixed prosthodontics is worried about reestablishing teeth utilizing rebuilding

2) Reestablish function (mastication, speech)

3) Occlusal stability (prevent tilting, drifting, rotation and over-eruption of

2) Pulpal harm (tooth preparation opens dentinal tubules providing a connection

3) Periodontal status of remaining dentition at a firm and acceptable level.

5) Binding of periodontally compromised teeth to increase occlusal stability,

6) As a method for fixed maintenance after orthodontic treatment or extraction.

7) Patient with unacceptable for implants construction. This might be because of

2) Patients with Para function e.g. bruxism [ Dayanik S, 2016]

3) Mobile tooth raises hazard of de-bonding. [Gulati JS et al., 2016]

4) Maligned teeth causing in poor aesthetics and communal path of insertion.

6) Increased danger of caries because of increased difficulty in maintaining oral

7) Increased danger of loss of vitality.

8) Allergy to base metal alloys e.g. nickel. [Gulati JS et al., 2016]

Fixed-fixed bridges: A fixed-fixed bridge refers to a pontic which is connected to a

Fixed-movable: The pontic is firmly connected to a retainer at one side of the

Adhesive bridge: An alternative to the traditional bridge is the adhesive bridge

Combination Designs: The combination of elements of different conventional

Hybrid Designs: Bridges that includes elements of both conventional and

Advantages: [Planning and Making Crowns and Bridges, Fourth Edition,2006]

3) Most preferable design for elongated spans.

4) Construction is moderately direct.

Preparations necessity to be parallel which may require broad tooth preparation.

1) Achieving parallel preparations is thought-provoking. It is imperative to keep

2) Abutments are real retainers need broad extensive preparation.

3) Cemented as a single unit which may be challenging.

3) Permit slight movements of teeth.

4) Cementation is more direct as components can be cemented distinctly

1) Not suitable for long spans.

2) Complex design for the laboratory to build.

3) Temporary bridge is complex to create.

1) Only one abutment tooth is necessary for conservative treatment.

2) Damaging parallel preparation is not required here.

3) Most suitable design when taking place of anterior.

4) Maintenance and oral clearance is calmer for the patient.

1) Span length restricted to one pontic because of leverage on the abutment

2) Rigid design to avoid alteration or distortion.

3) Tipping or tilting of abutment teeth due to occlusal load.

1) Huge surface region providing better retention and stability.