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A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years.

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.

Algorithms↗

Longevity of two-unit cantilevered resin-bonded fixed partial dentures.

PURPOSE: To examine the clinical performance of two-unit cantilevered resin-bonded fixed partial dentures that were inserted at The Prince Philip Dental Hospital, Hong Kong by students and staff between 1992 and 1998. MATERIALS AND METHODS: A search of the Hospital computer records system revealed a list of 130 patients who had received two-unit cantilevered resin-bonded fixed partial dentures (RBFPD) placed more than 24 months previous to the review date. For each patient clinically examined, the following data were recorded: gender, age, operator, cementation date, endodontic treatment if performed, bone support, tooth mobility, the presence of shimstock contacts on abutment or pontic in intercuspal position, the presence of interproximal contacts adjacent to the prosthesis assessed by dental floss. Date of any debonds with subsequent treatment was recorded and the patient was asked qualitative questions about their prosthesis. RESULTS: 82 prostheses were placed in 69 patients and were found to have a mean service life of 36.7 +/- 15.4 months and a range of 4.3 months to 95.4 months. In total, four prostheses were reported to have debonded resulting in a clinical retention rate of 95.1%. No rotation, drifting or tipping was observed for any of the prostheses during the time of this study. Overall patients' satisfaction with RBFPDs was good with an average assessment rating of 8.2.

Adolescent↗

Fixed partial dentures supported by natural teeth and Brånemark system implants: a 3-year report.

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.

Adult↗

Histologic evaluation of the periodontium of abutment teeth in combination implant/tooth fixed partial denture.

The histologic response of the periodontal tissues of teeth rigidly joined to implants with a fixed partial denture was evaluated using light microscopy. The fourth premolar of a dog was connected to implants placed in the first and second premolar position with a fixed partial denture. The restored teeth were under function for periods of 6, 12, 18, and 24 months, with unrestored fourth premolars as controls. The histology of the periodontal ligament on the fourth premolar was found to be similar in the control and the restored teeth. The periodontal tissues contained a minimal amount of inflammatory cell infiltrate. The crestal bone was cortical in nature, showing no periodontal breakdown. The orientation of the periodontal fibers was easily determined, indicating that minimal remodeling had taken place. The number and morphology of the blood vessels were also similar in the control and the treated teeth. The lack of inflammation and stability of the periodontal tissue suggested that the use of combination implant-to-natural-teeth restorations with rigid joints in this animal model does not result in deleterious effects on the periodontal tissues and that the forces placed on the tissues are within the remodeling capabilities of the teeth.

Animals↗

The effect of connector design on cement retention in an implant and natural tooth-supported fixed partial denture.

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).

Bicuspid↗

Fracture resistance of pressable glass-ceramic fixed partial dentures.

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.

Ceramics↗

Two-year clinical evaluation of lithia-disilicate-based all-ceramic crowns and fixed partial dentures.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of crowns and fixed partial dentures (FPDs) made with the Empress 2 system over a 2-year period. METHODS: Twenty anterior or posterior all-ceramic (Empress 2) crowns and 20 anterior or posterior, three-unit fixed partial dentures were fabricated for 15 patients. Evaluations of the restorations were performed at baseline and once a year during the 2-year follow-up period. U.S. Public Health Service criteria were used to examine the marginal adaptation, color match, secondary caries and visible fractures in the restorations. Survival rate of the restorations were determined using Kaplan-Meier statistical analysis. RESULTS: U.S. Public Health Service criteria showed 100% Alpha scores concerning recurrent caries for both crowns and FPDs. No crown fractures were observed during the 2-year follow-up, however, 10 (50%) catastrophic failures of FPDs occurred. Five (25%) failures occurred within the 1-year clinical period and the others (25%) within the second year. SIGNIFICANCE: Single unit Empress 2 all-ceramic crowns exhibited a satisfactory clinical performance over 2-year period. Furthermore, the high fracture rate of Empress 2 FPDs limits the usage of Empress 2 for the fabrication of all-ceramic FPD.

Adult↗

Five-year study of all-porcelain veneer fixed partial dentures.

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.

Composite Resins↗

Cross-sectional study of patients fitted with fixed partial dentures with special reference to the caries situation.

The caries situation among 30 patients with fixed partial dentures was examined 3 yr after cementation of the constructions. The fit of the crowns on the abutment teeth, the size of the interproximal areas and the relation between the crown margin and the gingival margin were registered. Risk factors for caries development, such as salivary factors, microbiologic factors, oral hygiene and diet were evaluated for each patient. During the 3-yr period 54 caries lesions occurred in 25 patients. Eleven lesions were found on abutment teeth. Two were located on the root surfaces unconnected with the crown margin (greater than 2mm from the gingival margin), three were recurrent lesions, where the crown margin was located above the gingival margin but closer than 2 mm and six were recurrent lesions where the crown margin was located under the gingival margin. No single caries risk factor seemed to be so closely correlated to the number of caries lesions developed that it could be used alone to select of patients at risk. When the sum of the assumed negative factors was used, more caries was found among the patients with three or more factors with negative values in the group as a whole. However, predicting the development of caries in an individual case with a high degree of probability seems to be complicated. Generally speaking there was no indication that caries disease development was caused by the presence of the fixed partial denture per se.

Adult↗

The relevance of a new generation of monobloc posts and impression copings for implant-supported fixed partial dentures: a 2-year clinical prospective study with the FM-Clip system on EVL implants (SERF).

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.

Dental Abutments↗

Frequency and location of artificial crowns and fixed partial dentures constructed at a dental school.

The material consists of patients who received single crowns and fixed partial dentures at the Department of Prosthetics, Dental Faculty, University of Oslo in the period 1967-73. Two-thirds of the patients were women, and about two-thirds of the restorations were made in the maxilla. A total of 3275 crowns were received by 2145 patients. On average, maxillary teeth were crowned 7 years earlier than mandibular teeth. A total of 1393 fixed partial dentures, consisting of 6835 units, were made for 1368 patients.

Adolescent↗

Use of an implant in repair of a fixed partial denture. A clinical report.

A repair technique for a fractured solder joint in a multiple-unit fixed partial denture has been presented. The advantages of this technique include (1) retention of part of an existing restoration; (2) provision of additional support to minimize future fracture; (3) removal of the implant crown for periodic evaluation and/or treatment; and (4) retention of a fixed partial denture where a removable prosthesis might otherwise be needed. The primary disadvantage of this technique is the time and expense associated with implant placement.

Adult↗

Multi-unit fixed partial denture for a bilateral cleft palate patient: a clinical report.

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.

Adult↗

Distortion of ceramometal fixed partial dentures during the firing cycle.

1. Distortion does occur in the body of curved, long-span fixed partial denture frameworks during the porcelain firing cycle. 2. This distortion is a result of changes in the metal as well as the contraction of fired porcelain. 3. The greatest distortional changes occur during the degassing stage and the final glaze stage of the porcelain firing cycle. 4. Distortion incurred by the application and firing of the porcelain is reversible. When the porcelain is chemically removed from the framework, there is an elastic rebound. 5. Distortion is clinically important in that it may lead to detectable marginal openings. 6. The distortion pattern observed in the curved fixed partial denture is a closing of the posterior or lingual dimensions and labial movement in the anterior dimension. This indicates the effect of the contracting porcelain on the metal framework.

Dental Alloys↗

Modification of stresses surrounding abutment teeth for fixed partial dentures induced by various levels of periodontal support: a photoelastic study.

A photoelastic replica system was used to study stresses produced within the periodontium of abutment teeth for a fixed partial denture. Three replicas, each representing a different level of periodontal support, were constructed. Abutment teeth were subjected to occlusal forces and examined in a polariscope before and after prosthesis construction. Stress distributions and concentrations produced in the periodontium of abutment teeth by an occlusal force were favorably altered by the placement of a fixed partial denture. Stress concentrations produced in the periodontium of abutment teeth were notably altered by a moderate (20%) loss of support. Further (40%) loss of periodontium did not result in appreciably additional change. The stress patterns produced in the periodontium of both replicas which simulated loss of periodontium were also favorably altered by the placement of a fixed partial denture.

Dental Abutments↗

Retrospective evaluation of complete-arch fixed partial dentures connecting teeth and implant abutments in patients with normal and reduced periodontal support.

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.

Adult↗

Long-term observations of extensive fixed partial dentures on mandibular canine teeth.

Twelve patients were followed for 15 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposite to a complete maxillary denture. Four constructions failed and had to be removed but four were still in function after 15 years. Four patients died during the observation period still wearing their constructions. Endodontic complications, pulpal necrosis and loss of retention of posts were the most frequent, while caries and periodontal lesions were rare. The maintenance costs over the years were fairly low even compared to maintenance costs for patients treated with implants. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties adapting to removable dentures.

Adult↗