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A 2-year report on 10 acid-etched fixed partial dentures was presented. Similar to other studies, it indicates that the acid-etched fixed partial denture is a clinically acceptable restoration for properly selected patients.
When single-tooth implants are not appropriate, the use of resin-bonded fixed partial dentures is a preferred treatment option when the abutments are relatively sound. However, the use of resin-bonded fixed partial dentures (RBFPDs) for replacing two or more missing teeth is considered to have a guarded prognosis, as long-span RBFPDs have been shown to be less successful than single pontic prostheses. The use of properly modified nonrigid connectors may well improve the success of long-span RBFPDs by reducing harmful interabutment stresses that appear to be responsible for retainer debonding in long-span RBFPDs. For such long-span prostheses, it is advised that the major retainer have wraparound on at least three surfaces of the abutment or have strategically placed opposing axial grooves or slots. It is considered essential that the connector allow interabutment movement in both the horizontal and vertical planes so that the retainer with the greater resistance and retention form does not stress and possibly debond the minor retainer. The upside-down positioning of the nonrigid connector and the matrix incorporated with the major retainer is considered important for successful maintenance, if a debond should occur due to greater loading on the major retainer, because it can be removed and recemented easily. Clinical cases are described that replace two or more missing teeth using fixed-movable RBFPDs with nonrigid connectors.
This study has shown that treatment with distally extending cantilever fixed partial dentures is a favorable alternative to treatment with removable partial dentures in elderly patients with reduced dentition. In patients with anterior teeth and one or two premolar teeth remaining in the mandible, sufficient occlusal stabilization for a maxillary complete denture was provided by a two- or three-unit cantilever fixed partial denture. A pronounced improvement in chewing function and stability of the maxillary denture was expressed, even by patients who were previously well adapted to wearing removable partial dentures.
PURPOSE: This study was conducted to assess the quality of impressions and tooth preparations sent to dental laboratories in Jordan and to determine the technical capabilities of these laboratories to construct fixed partial dentures. MATERIALS AND METHODS: A sample of 136 impressions and stone casts were examined for clinical errors in 35 laboratories that construct fixed partial dentures. They were sorted into unusable, unsatisfactory, acceptable, or satisfactory categories. The type of impression material and tray, opposing arch impressions, and occlusal records were noted. Instructions to technicians were assessed for completeness and clarity. Information regarding laboratory staff and equipment were collected. RESULTS: Half of the specimens inspected were categorized as unusable or unsatisfactory; these were found in commercial laboratories. They showed at least one clinical error such as drags or indefinite finishing lines in impressions and inadequate reduction, undercuts, or obvious taper on stone casts. Alginate impression material was used for 65% of the cases. Only 27% of specimens were accompanied with instructions; of these 22% were graded poor. No occlusal records were available with 54% of the specimens and no articulators were used except in dental school laboratories. The dental schools and some commercial laboratories had the best staff and equipment and were more capable of fabricating fixed partial dentures than those of the Ministry of Health and the Royal Med cal Services. CONCLUSION: The quality of abutment preparation and impressions were unsatisfactory or unusable in 50% of cases. Of the 37 available instructions 8 were not clear. The dental schools and some commercial laboratories were technically capable of producing good quality fixed partial dentures.
Twelve patients were followed for 5 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposed by a complete maxillary denture. Two fixed dentures had to be removed, one because of an abutment tooth root-fracture and one because of rapid marginal bone loss in a terminal stage of leukemia. Caries and periodontal lesions were rare, but other complications, principally related to endodontics, occurred. All complications were amenable to standard treatment procedures. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties in adapting to removable dentures.
Inlay fixed partial dentures luted by use of adhesive procedures offer a clinical alternative for the restoration of single missing posterior teeth. The introduction of ceromers and fiber-reinforced composites and the continuous improvement of adhesive systems and luting agents make this type of restoration possible, offering good aesthetic and functional results. The procedure is minimally invasive and conservative. This clinical report reviews the factors influencing the diagnosis and the clinical indications for an inlay fixed partial denture. In addition, a patient treatment is presented to illustrate the clinical procedures involved.
Verification of the accuracy of the master cast for an implant-supported fixed partial denture will reduce the chair time and laboratory costs of implant prosthodontic treatment. A wire is usually luted in the mouth to machined components that have been secured to the implants, and the luted assembly is then transferred to the cast to evaluate the positional accuracy of the implant analogs. Unless this wire is dead soft, inaccuracies as a result of elastic memory of the wire can occur. Also, if the wire is not completely rigid, it can be distorted during handling. This article describes a more reliable verification jig for an implant-supported fixed partial denture that can be fabricated with 1.5 mm thick aluminum strips that are luted to the implant components. The use of two aluminum strips creates a metal framework that is rigid and not easily distorted. Also the aluminum pieces do not have elastic memory because they were cut and not bent to shape.
A severe allergic reaction to a porcelain-fused-to-metal fixed partial denture containing 79% palladium, 2% gold, and 19% copper, resulting in a variety of symptoms and hospitalization of the patient, is reported. The reaction occurred 4 hours after cementation of the fixed partial denture. Suggestions for use of nongold metal alloys are discussed.
STATEMENT OF PROBLEM: Resin-bonded, glass fiber-reinforced composite fixed partial dentures (FPDs) have been under development for some time. There is a lack of data regarding the clinical usefulness of such prostheses. PURPOSE: The clinical performance of 31 resin-bonded, glass fiber-reinforced composite fixed partial dentures was evaluated in a preliminary study. MATERIAL AND METHODS: The prostheses were made to replace 1 to 3 missing maxillary or mandibular teeth in each of 31 patients. The prostheses had a framework made of continuous unidirectional E-glass fibers with multiphase polymer matrix and light-polymerized particulate composite resin veneering. The prostheses were examined after 6-month periods for up to 24 months (mean follow-up time was 14 months). Partial or total debonding of the prostheses or the framework fracture was considered a treatment failure. RESULTS: Two prostheses debonded during the follow-up period; 1 debonding was related to improper occlusal adjustment and the other to unknown reasons. Kaplan-Meier survival probability at 24 months was 93%. No framework fractures were observed. CONCLUSION: The results of this preliminary study suggest that the resin-bonded, glass fiber-reinforced FPDs may be an alternative for resin-bonded FPDs with a cast metal framework.
OBJECTIVES: The objective of this systematic review was to assess the survival of cantilever fixed partial dentures (FPDs) and the incidence of biological and technical complications. METHODS: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poisson regression to obtain summary estimates of 10-year survival proportions. RESULTS: From a yield of 3658 titles and 211 abstracts, 81 articles were selected for full-text analysis, finally resulting in 13 studies that met the inclusion criteria. Meta-analysis of these studies resulted in an estimated survival rate of cantilever FPDs of 81.8% (95 percent confidence interval (95% CI): 78.2-84.9%) and success rate (free of all complications) of 63% (95% CI: 54.7-70.2%) after 10 years. The most common biological complication was loss of pulp vitality (32.6%) followed by caries at abutment teeth (9.1%). After a 10-year observation period 2.6% of the FPDs were lost as a result of dental caries and 1% due to recurrent periodontitis. The most frequent technical complication was loss of retention (16.1%) followed by material fractures (5.9%). The cumulative incidence of fractures of abutment teeth was 2.9% and 2.4% of the FPDs were lost as a result of abutment tooth fracture after an observation period of 10 years. CONCLUSION: This systematic review on cantilever fixed partial dentures indicated that survival and success rates of cantilever fixed partial dentures were lower than those of conventional end-abutment supported FPDs described in a review by Tan et al. (2004) and biological and technical complications were frequent.
PURPOSE: To evaluate fixed partial dentures (FPDs) supported by a combination of natural teeth and implants in a variety of clinical situations. MATERIALS AND METHODS: In 30 patients, 86 teeth and 85 implants were used as supports for 30 FPDs of varying extension (mean = 8.6 units); 23 in the maxilla and 7 in the mandible. The prostheses had a removable section fastened with screws to both the implants and to a section cemented on the supporting teeth, and were thus functioning as rigid, fixed partial dentures. RESULTS: Five implants were lost prior to the placement of prostheses, 2 were lost after loading, giving survival rates of 91.0% in the maxilla and 95.5% in the mandible. Complications were predominantly soft tissue-related and were all amenable to treatments. One patient was lost to follow-up. The remaining 29 FPDs remained stable throughout the 3-year observation period. DISCUSSION: Changes in plaque accumulated, bleeding on probing, pocket depths, and marginal bone level were acceptable. The survival rate of implants was comparable to that of similar studies. Further investigations are needed with regard to design for such FPDs. CONCLUSION: These findings, together with the patient satisfaction experienced, indicated that the combined support of implants and teeth for fixed prostheses may be appropriate treatment for patients.
This study investigated the effect of connector design, rigid or nonrigid, on cement retention in a combined implant and natural tooth-supported fixed partial denture. A prepared natural tooth was placed in a Plexiglas block in a manner that it could move approximately the same as a healthy premolar. An endosseous implant was placed in the block so that it was immobile. Joining the prepared tooth and implant was a fixed partial denture that could be made rigid or nonrigid. The natural tooth retainer was cemented to the prepared tooth, and the implant retainer was affixed to the implant fixture with a gold screw. One year of stress was applied to the fixed partial denture by a force simulation machine. Twenty randomly ordered tests were completed, 10 of each connector design. Retentive values for the cemented retainers were recorded and statistically compared by use of Student's independent t test. No significant difference in cement retentive strength between designs was found (p less than 0.05).
The aim of the present study was to evaluate the mechanical strength of the Empress2 system, which is based on the use of a high-strength glass--ceramic core of lithium disilicate, and the fracture resistance of fixed partial dentures fabricated with this material. To evaluate mechanical strength, four types of ceramic materials were tested for four-point flexural strength and diametral tensile strength: Empress2 core material, Empress2 layering porcelain, conventional Empress material and Dicor. Then, using Empress2, conventional Empress and Dicor, actual clinical type anterior fixed partial dentures were fabricated for fracture testing. The results showed that the Empress2 core material, at 329 MPa, has more than twice the flexural strength of conventional materials and at 271 MPa, more than four times the diametral tensile strength of conventional materials. Furthermore, fixed partial dentures fabricated with Empress2 had a fracture resistance of 1424 N. That is, they were more than twice as fracture resistant as fixed partial dentures made with conventional materials.
Improvements in enamel-dentinal bonding systems combined with the introduction of new ceramics have encouraged replacement of missing anterior teeth in specific patients with porcelain veneer fixed partial dentures. Metal substructures are not needed, and more natural tooth structure can be preserved because the preparation of abutments is conservative. Twelve porcelain veneer fixed partial dentures were monitored for 5 years, and fractures attributed to degradation of the gingival margins occurred in the veneer surface of the fixed partial dentures. The success rate of 75% was dependent on rigid patient selection criteria, strength of the major connectors, and precise adjustment of occlusion to prevent overloading. The failing margins were attributed to the degeneration, attrition, and deterioration of the composite resin cements. Despite these limitations, patients were extremely satisfied with the esthetics. Improvement in the mechanical properties of composite resin cement will ameliorate the prognosis with this approach.
The use of monobloc posts for implant-supported fixed partial dentures is interesting for biomechanical and biological reasons, but it suffers from a lack of precision during the impression phase. The use of a new generation of monobloc posts associated with individual impression copings with a piston offers a simple and efficient impression procedure for small and medium implant-supported fixed partial dentures. This article presents the FM-Clip system for EVL implants composed of new straight monobloc posts and small impression copings with a piston for precise impressions and easy production of implant-supported fixed partial dentures.
Patients with cleft palates eventually require definitive fixed or removable dental prostheses after the maintenance of arch alignment and occlusal relationship during adolescence. This case report presents application of a resin composite veneered fixed partial denture utilized as a definitive prosthesis for a bilateral cleft palate patient after stable occlusion had been established orthodontically. The composite veneered long span fixed partial denture provides adequate aesthetics and function.
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STATEMENT OF PROBLEM: The clinical outcome of complete-arch fixed prostheses supported by implants and natural tooth abutments in patients with normal or reduced periodontal support has been reported by few studies, with controversial results. PURPOSE: The purpose of this study was to report on the implant success rate, prosthetic complications, and the occurrence of tooth intrusion, when complete-arch fixed prostheses, supported by a combination of implants and teeth, were fabricated for patients with normal and reduced periodontal support. MATERIAL AND METHODS: Nineteen patients with residual teeth that served as abutments were consecutively treated with combined tooth- and implant-supported complete-arch fixed prostheses and were retrospectively evaluated after a period varying from 24 to 94 months. Nine patients showed reduced periodontal support as a result of periodontal disease and treatment (RPS group), and 10 patients had normal periodontal support of the abutment teeth (more than 2/3 of periodontal support [NPS group]). Ninety implants and 72 tooth abutments were used to support 19 fixed partial dentures. Screw- and cement-retained metal-ceramic and metal-resin prostheses were fabricated with rigid and nonrigid connectors. Implant survival and success rates, occurrence of caries and tooth intrusion, and prosthetic complications were recorded. The number of teeth, implants, prosthetic units, fixed partial dentures, and nonrigid connectors were compared with a t test to assess differences between the 2 groups, while data for the occurrence of intrusions and prosthetic complications were compared with the Fisher exact test (alpha=.05). RESULTS: One of the 90 implants was lost (99% survival rate) over 24 to 94 months, while 3 implants showed more than 2 mm of crestal bone loss (96% success rate) over the same period. No caries were detected, but 5.6% (4/72) of the abutment teeth exhibited intrusion. Intrusion of abutment teeth was noted in 3 patients who had normal periodontal support (13% of teeth in NPS group) of the abutment teeth and was associated with nonrigid connectors. No intrusion of teeth was noted in the patients exhibiting reduced periodontal support regardless of the type of connector or when a rigid connector was used for either group. The number of intruded teeth was significantly greater in patients with intact periodontal support (P=.03). CONCLUSIONS: Complete-arch fixed prosthesis supported by implant and tooth abutments may be associated with intrusion of teeth with intact periodontal support when nonrigid connectors are used to join the implant- and tooth-supported sections of the prostheses. However, fixed partial dentures supported by implants and teeth with reduced periodontal support were not associated with tooth intrusion, regardless of the type of connectors used.