EPA 4C: Partial Edentulous Fixed Partial Denture - Tooth Supported

Isolation and Hard/ Soft Tissue Management

• No iatrogenic damage to adjacent tooth or soft tissue
• Complete visualization of margin

• Slight damage to adjacent tooth that can be polished
• Minimal tissue damage consistent with equi/subgingival preparations

• Minor damage to adjacent tooth, requiring enamel recontouring
• Soft tissue damage inconsistent with preparation that can be managed by a gingival recontour

• Significant damage to adjacent tooth, requiring a restoration
• Significant soft tissue damage requiring specialized care (e.g. sutures)

PREPARATION

External Outline

Margin:

• Located on sound tooth structure and supra gingival (0-0.5 mm)
• Regular in form

Margin:

• Slightly irregular

Margin:

• Located on sound tooth structure and slightly supra/sub gingival (up to 1mm)
• Decidedly irregular but recognized

Margins:

• Located on restorative material or caries
• Located supra gingival by 1.5 mm or >1 mm sub gingival
• Presence of J margin or lip of unsupported enamel
• Ill-defined/ not recognized

Internal Outline

• Anatomical preparation ideal for the chosen restorative material
• Margin width is ideal for the chosen restorative material
• Absence of caries and adequate direct restorations

• Slight anatomical deviation or over/under-reduced areas <0.5 mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width is adequate

• Significant anatomical deviation with over/under reduction by 0.5-0.8mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width deviates >0.5mm from ideal
• Inadequate direct restorations

• Gross anatomical deviations with over/under-reduction > 0.8mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width is under reduced (<0.3 (gold), 0.5 (zirconia), <1mm (ceramics/PFM)) or over reduced > 1.5mm
• Presence of unaddressed caries or missing direct restorations

Taper

• Taper ideal (5-10°TOC)

• Taper slightly excessive (10-15°TOC)
• Minor undercuts that maintain ideal margin width

• Taper inadequate (2-5°) or decidedly excessive (15-25°TOC)
• Blockable undercuts that maintain minimum margin width

• No taper or grossly excessive taper (>25°TOC)
• Gross undercuts (margin less than minimum width after blockout)

Bridge Factor/ Common path of insertion

Common path of draw exists

Common path of draw exists but requires slight alteration of the direction of prosthesis to allow seating

Common path of draw exists but requires significant alteration of the direction of prosthesis to allow seating, adversely impacting proximal contacts and embrasures

Common path of draw does not exist without modifying one or both preparations

Preparation Finish and shade selection

• Surface and margin uniformly smooth
• Rounded line/point angles
• Appropriate shade record

• Surface and margin lightly rough, pitted, or lacking finish

• Surface and margin decidedly rough or pitted

• Surface and margin deeply pitted or grooved
• Sharp line/point angles
• Missing shade record

Gingival Retraction and Impression

• Finish line accurately captured circumferentially
• All teeth accurately captured without voids/distortion/ burn through
• Appropriate impression materials and tray selection
• Adequate opposing arch record and accurate inter-occlusal record

• Minor void present along internal outline of prep that will not affect crown fit
• Final impression/ opposing arch impression shows minor voids/ distortion/ burn through in non-critical areas

• Final impression/ opposing arch impression shows major voids/ distortion/ burn through in non-critical areas

• Preparation surface and finish line inaccurately captured circumferentially
• Voids/ distortion in critical areas of remaining teeth (proximal surface of adjacent teeth or occlusal surfaces)
• Inappropriate impression material or tray selection
• Inadequate/ missing opposing arch impression/ interocclusal record that precludes crown fabrication

RESTORATION (PROVISIONAL/DEFINITIVE)

Intaglio fit and Stability

• Free of contamination/ debris/ voids
• Complete seating with stable, passive fit. Verified with a radiograph

• Stable with light premature interferences till complete seating

• Minor voids/ debris
• Stable with significant premature interferences till complete seating. Missing pre-cementation radiograph

• Gross contamination/ debris/ voids
• Incomplete seating with severe rocking/ rotation

Marginal Integrity

• Vertically closed
• Horizontally extends flush with finish line width

• Horizontal margin excess (overhang) or deficiency (over finished) in some areas

• Moderate horizontal margin excess (overhang) or deficiency (short)

• Vertical margin deficiency (open)
• Gross horizontal excess (overhang)/ deficiency (short)

Occlusal Anatomy and Contacts

• Anatomy conforms to existing tooth form
• Multiple centric contacts present with ideal intensity and location. Restored with mutually protected occlusal scheme

• Anatomy lacks definition
• Light/ heavy or insufficient centric contacts present

• Significant deviation in anatomy in some areas
• Premature occlusal contacts in centric or interferences in balancing or non-functional movements

• Anatomy absent
• Gross hyper occlusion or infra-occlusion

Surface Contour, Proximal Contacts and Finish

• Ideal anatomic contours and embrasures
• Convex proximal contacts that are visibly closed, appropriately located with the right intensity
• Highly polished surface

• Slightly over/ under contoured surface
• Proximal contacts are visibly closed but lack intensity or show slight variation in location
• Surface slightly rough in finish

• Decidedly over/ under-contoured surface or presence of soft tissue impingement
• Concave, irregular or tight proximal contacts
• Surface decidedly rough or pitted

• Grossly over- or under-contoured
• Proximal contact visually open
• Surface deeply pitted or grooved
• Fractured provisional

Bridge Factor/ Common path of insertion

Common path of draw exists without rotation of prosthesis while seating

Common path of draw exists but requires slight alteration of the direction of prosthesis to allow seating

Common path of draw exists but requires significant alteration of the direction of prosthesis to allow seating, adversely impacting proximal contacts and embrasures

Common path of draw does not exist. Recontouring/ New impression may be needed

Cementation

• Appropriate cementation protocol used under adequate isolation as indicated
• Absence of residual cement. Post cementation radiograph recorded

• Minor debris of residual cement
• Absence of post cementation radiograph

• Inappropriate cementation protocol used or inadequate isolation maintained
• Gross presence of residual cement