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This review of the evolution of the resin-bonded fixed partial denture (RBFPD) design, from the original "prepless" restoration to the present prosthesis, requiring careful treatment planning and technical skill, also discusses the materials used to enhance the longevity of this restoration. That, in turn, increases the patient's confidence in both the dentist and the prosthesis itself.
Four-unit fixed partial dentures were fabricated as a one-piece casting or as two-piece castings joined by soldering prior to the addition of porcelain. The accuracy of the two techniques was compared and evaluated using an anatomic cast-metal master model. All procedures, including SEM measurements, were performed directly on the master model. The cast one-piece units had smaller vertical marginal openings than did the soldered units. The rigid nature of the abutments evokes the problems occurring with osseointegrated implants.
PURPOSE: This pilot clinical trial evaluated the clinical behavior of 3-unit inlay fixed partial dentures (IFPDs) made of the glass-fiber composite system SR Adoro/Vectris and luted with 2 different bonding systems over an observation period of 2 years. MATERIALS AND METHODS: Thirty-nine glass-fiber-reinforced composite IFPDs were made to replace 1 missing maxillary or mandibular tooth. Nineteen IFPDs were randomly assigned to group A and luted with a 2-step bonding system (Excite DSC), while the other 20 IFPDs of group B were cemented with a 3-step adhesive (Syntac). Events such as partial or total debonding of the IFPDs, fracture of the framework, or veneer and fiber exposures were considered failures. Color match, marginal discoloration, secondary caries, marginal adaptation, postoperative sensitivity, and surface texture were evaluated according to the United States Public Health Service modified criteria. RESULTS: Two debondings and 2 fiber exposures occurred during the observation period. All failures occurred in group A. Some fatigue microcracks in the pontic area of the 2 detached IFPDs were observed under scanning electron microscopy. The postoperative sensitivity of group A was much higher than that of group B, and the abutments luted with Excite DCS showed postoperative sensitivity during the first month in 42.2% of cases. The sensitivity disappeared completely after 6 months. Statistical analysis indicated significant differences in postoperative sensitivity (P < .05) between the 2 groups. CONCLUSION: The IFPDs bonded with a 3-step adhesive demonstrated good clinical service in the short observation period. The microfractures of the layering material observed on the debonded IFPDs may suggest excessive flexibility of the fiber structures, which occurs if the framework is fabricated without observing the recommended dimensions.
PURPOSE: Many restorative systems have become commercially available that are based on fiber-reinforced polymers (FRP) for production of fixed partial dentures. However, the clinical documentation of their use has not been systematically reviewed and critically appraised. This systematic review aimed to identify the scientific documentation of all commercially available products within this material group. MATERIALS AND METHODS: MEDLINE was searched for all clinical and laboratory studies on FRP, and papers were browsed to identify product names. Moreover, the Internet was searched to find manufacturers of FRP products. Also, several large trade exhibitions were visited to identify products and manufacturers. All papers that included any data from a clinical setting of an identifiable product were critically appraised. Each product was categorized according to the scientific clinical documentation of their intended clinical use. RESULTS: Eleven commercial products were identified. The scientific clinical documentation of these products varied markedly, but was generally poor. No randomized controlled trials have been carried out on FRPs versus, eg, conventional treatments, nor are any long-term cohort studies available. None of the products demonstrate good evidence for usage as a technical solution to permanently replace lost teeth. CONCLUSION: The use of FRP for fixed partial dentures must still be regarded as experimental.
Axially directed occlusal forces over unilateral posterior two-unit cantilever segments of cross-arch fixed partial dentures were measured during natural functioning by using built-in transducers, one in each cantilever unit. The mean local maximal occluding and maximal chewing forces were significantly larger over the first (124 N and 64 N) than over the second (21 N and 29 N) cantilever unit. The average intraindividual ratio between the forces over the first and second cantilever unit amounted to 12:1 for maximal occlusion and 3:1 for maximal chewing. Despite the smaller mean total maximal chewing (92 N) than mean total maximal occluding cantilever force (145 N), the resulting axially directed mean bending moments in the joint between the distal abutment crown and the cantilever segment did not differ significantly. This is explained by the larger mean maximal chewing (29 N) than mean maximal occluding (21 N) force over the second cantilever unit. This demonstrated that not only the magnitude of occluding and chewing forces over cantilever segments but also their distribution along the cantilevers is of importance for the magnitude of functional stress created in cantilever fixed prosthesis.
In light of the increasing demand for fixed prosthetics by today's patients, the author felt the time was right for a review of an area of fixed prosthetics that is neither well understood nor well accepted. The cantilever fixed partial denture (FPD) requires more time to treatment plan and place than other comparable fixed prosthetics. However, if the necessary criteria are met, the final results can be very rewarding for the practitioner and the patient from both an esthetic and a functional standpoint. This article discusses various factors that impact on the practitioner's ability to place a cantilever FPD with the expectation of long-term success, as well as other related areas of treatment planning.
This article describes the treatment of a patient for whom a fiber-composite laminate dowel and core and polyethylene fiber were used as a conservative alternative to provide a dowel-and-core and fixed partial denture foundation. The treatment plan included removing the existing restoration on the maxillary right first molar, placing a fiber-reinforced resin dowel and core for retention and reinforcement of the maxillary first premolar, and fabricating a definitive restoration using polyethylene fiber to reinforce the fixed partial denture.
After 7 years of clinical experience, the alumina ceramic, In-Ceram, can be regarded as a well-proven material for all-ceramic crowns. Because of its high strength, this material can also be used for small all-ceramic fixed partial dentures. First attempts at using this material for resin-bonded prostheses revealed a high failure rate. The aim of this article is to present a new preparation design for all-ceramic resin-bonded fixed partial dentures that allows fabrication of highly esthetic and also tooth-saving adhesive prostheses. Clinical results over a period of 4 years revealed that they are strong enough to replace anterior teeth. Nevertheless, positive long-term clinical results are necessary before a general recommendation can be given for this kind of prosthesis.
PURPOSE: The aim of the present clinical trial was to evaluate the 12-month success rate of titanium dental implants placed in the posterior mandible and immediately loaded with 3-unit fixed partial dentures. MATERIALS AND METHODS: Patients with missing mandibular premolars and molars were enrolled in this study. To be included in the study, the implants had to show good primary stability. Implant stability was measured with resonance frequency analysis using the Osstell device (Integration Diagnostics). Implants were included in the study when the stability quotient (ISQ) exceeded 62. Clinical measurements, such as width of keratinized tissue, ISQ, and radiographic assessment of peri-implant bone crest levels, were performed at baseline and at the 12-month follow-up. The comparison between the baseline and the 12-month visits was performed with the Student t test for paired data (statistically significant at a level of alpha = 0.05). RESULTS: Forty implants with a sandblasted, large grit, acid-etched (SLA) surface (Straumann) were placed in 20 patients. At 12 months, only 1 implant had been lost because of an acute infection. The remaining 39 implants were successful, resulting in a 1-year success rate of 97.5%. Neither peri-implant bone levels, measured radiographically, nor implant stability changed significantly from baseline to the 12-month follow-up (P > .05). DISCUSSION: The immediate functional loading of implants placed in this case series study resulted in a satisfactory success rate. CONCLUSION: The findings from this clinical study showed that the placement of SLA transmucosal implants in the mandibular area and their immediate loading with 3-unit fixed partial dentures may be a safe and successful procedure.
1. A finite element model was devised to examine mechanical responses of the periodontium to loads applied to the model in vertical, oblique, and horizontal directions for an individual tooth having varied alveolar levels, splinted teeth, and a cantilever type of fixed partial denture. 2. Forces applied to the teeth are balanced by stresses generated within the periodontal membrane and alveolar bone. 3. It was substantiated that the teeth were evolved to carry axial types of loads, since stresses on the periodontium were smaller than those obtained for oblique or horizontal types of loads. Axial types of loads produce compressive stresses on the periodontium; oblique or horizontal types of loads produce zones of compressive and tensile stresses. 4. Mechanically, splinting teeth is a desirable procedure. 5. A cantilever type of fixed partial denture should have at least two abutments. It should not be used to replace more than one tooth.
In this in vitro study fracture strength and marginal adaptation of adhesive-fixed three-unit posterior fixed partial dentures made with two different fabrication modifications--with and without the retainer material "Single"--of the new fibreglass system Vectris/Targis and from the metal-free Al2O3-ceramic In-Ceram were examined. The quality of the marginal adaptation was characterised using SEM evaluation and dye penetration techniques. In-Ceram and Vectris/Targis with "Single" showed good marginal adaptation, both statistically significantly better than the modification without "Single". After thermal cycling and mechanical loading the fibreglass reinforced systems showed a significantly higher fracture strength than the In-Ceram.
There are many differences between full dentures on Brånemark implants and fixed partial dentures built on the same type of implants: due to some more critical anatomical conditions, the choice of number, position and length of the implants is more delicate; the need of an harmonious crown-gingival tissue relationship; higher occlusal forces than in edentalous cases; difficulty in satisfying aesthetic requirements and ease of hygiene. The surgical treatment plan, a pre-requesite to any surgery, permits to determine the length of implants, their number, their position, their long axis direction and the design of the surgical guide, which will indicate to the surgeon the location and the axis for drilling. If this axis is nearly parallel to the sagittal plane for mandibular implants, it will be angulated to that same plane for maxillary implants. In the latter cases, it is often necessary to use angulated transepithelial abutments in order to prevent the abutment screw from having an occlusal access. In order to perform the prosthetis, an impression should be taken with the transepithelial abutments. The final reconstruction can be preceded by a temporary prosthesis, then (or) transitory to await gingival stabilization and not overload the implant immediately after it has been connected with the abutment. The fixed partial denture can be secured with screws or cemented when it is of small size and it must satisfy the functional and aesthetic requirements of the patient. The choice of the material used on the occlusal surface is very important and varies depending on the case. Aesthetics should not be prevent an in easy hygiene. These objectives are not reached at the time the prosthesis is made but during the course of the surgical and prosthetic treatment. Single restorations are subjected to the rules pertaining to any fixed partial denture on implants, but have particular characteristics, such as the almost systematic elimination of the abutment and the absolute necessity of the correct placement of the implant. The single units are more easily subject to unscrewing for mechanical reasons. Although the use of implants is a valuable aid in cases of partial fixed restoration, it requires particular attention with regard to precision.
The choice to replace a single missing tooth can be based on the primary decision that the restorability of the tooth is in doubt. Many teeth are decimated by incipient or recurrent caries, trauma, endodontic complications, or periodontal disease which requires extraction. It is our objective to familiarize the participant with literature comparing success rates of fixed partial dentures and single-tooth implant restorations and a repertoire of prosthodontic techniques used in replacement of single missing teeth with osseointegrated dental implants. The fixed partial denture (FPD) has been regarded as the standard of care for some time in replacement of single and multiple missing teeth. Many studies surveying long term survival have been compiled and analyzed to arrive at a generalized outcome. Most of these studies arrive at common conclusions. Studies surveying success of single-tooth implant-supported restorations are not comparably abundant nor survey for comparable time as those for FPDs. Although, many of the outcomes are statistical survival estimates such as Kaplan-Meier survival tables, implant restorations in partially dentate patients are a predictable means of tooth replacement. There are certain factors which make FPD more appropriate and conversely factors which make an implant restoration more appropriate. Indications and contraindications for each treatment scenario will also be reviewed based on the literature and clinical experience. It is hoped that the practitioner will be able to appropriately identify those cases in which either an FPD or an implant restoration is the appropriate treatment option.
Treating internal resorption is one of dentistry's most difficult challenges. This pathological process is difficult to manage in an advanced stage. The usual treatment involves surgery or, in many cases, extraction of the resorbed tooth. It is often difficult for the patient to understand and accept such a radical treatment approach. This report of case illustrates severe internal resorption that destroyed a major portion of a key abutment tooth supporting an eight-unit fixed partial denture. The resorptive pathosis was treated by a nonsurgical endodontic approach. The severely damaged abutment was reinforced and restored so that the existing eight-unit fixed partial denture could be preserved. The patient was pleased with the method of treatment and was commended for seeking regular recall professional care. It would have been easy to postpone treatment as the problem was asymptomatic. However, to do so probably would have resulted in loss of the resorbed abutment tooth, thus creating a complex restorative situation. The original prosthesis is currently 14 years old, functioning well, and showing no apparent evidence of pathosis. Costly and time-consuming remake procedures were avoided and patient satisfaction was maintained.
This study compared the marginal fit of complete-arch fixed prostheses under simulated clinical conditions. Prostheses were made on casts constructed from three commonly used impression materials; polyether, polyvinyl siloxane (medium-viscosity and putty-wash), and reversible hydrocolloid. A maxillary dentoform with four abutment teeth was used as the master cast and six impressions were made with each material. Individual castings for each abutment were made on the stone casts. The abutment castings were luted together on the casts to provide a complete-arch fixed partial denture using a ticonium framework and acrylic resin. The marginal fit of the abutment castings was measured on the master cast before and after the prostheses were luted together. The polyether and both addition silicone impression materials were significantly more accurate than the reversible hydrocolloid in both situations. All of the single castings were clinically acceptable, but the luted restorations made from reversible hydrocolloids were not.
This article describes a practical and expeditious method of converting an existing fixed partial denture into an interim complete-denture prosthesis with minimal inconvenience to the patient. The esthetic, phonetic, and functional demands are maintained during the fabrication of the prosthesis.
STATEMENT OF PROBLEM: Provisional resins are used extensively during fixed prosthodontic treatment and exhibit varying degrees of color change/discoloration over time. Data are needed to help predict color stability of provisional resins. PURPOSE: The purpose of this in vitro study was to measure the color change of 12 provisional prosthodontic materials after immersion in artificial saliva and artificial saliva-coffee solutions for 1, 2, and 4 weeks. MATERIAL AND METHODS: Twelve provisional materials were studied. Methacrylates consisted of Alike, Jet, Temporary Bridge Resin, Unifast, and Zeta CC. Bis-acryl resins included Instatemp, Integrity, Luxatemp, Protemp Garant, Provipont, Provitec, and Temphase. Ten specimens (25.4 mm x 25.4 mm x 2.4 mm) of each material were fabricated. Five specimens were stored at 37 degrees C in artificial saliva and 5 were stored in a solution of artificial saliva (400 cc) and coffee (800 cc). Baseline color was measured using a colorimeter. Further color measurements were made after 1, 2, and 4 weeks of immersion. CIE L *a *b * values were recorded and color differences (DeltaE) between baseline and each storage interval were calculated using a 2-way ANOVA with Bonferroni adjustment for multiple comparisons in conjunction with an overall alpha=.05. RESULTS: Results indicated the presence of strong interaction between material and storage solution regardless of the aspect of color considered (P<.0001 for DeltaE, DeltaL *, Deltaa *, and Deltab *). Coffee solution relative to saliva solution had the most significant impact on color change for Luxatemp, Protemp, and Temphase materials at 4 weeks, but the greatest overall color change for both coffee and saliva solutions was found for Provipont (DeltaE=9.40 coffee; 8.51 saliva) and the least overall color change for both solutions was found for Zeta CC (DeltaE=0.31 coffee; 0.23 saliva). CONCLUSIONS: Under the conditions of this study, 12 provisional crown and fixed partial denture resins demonstrated varying tendency to discolor over a range of time periods when immersed in artificial saliva and artificial saliva-coffee solutions.
A discussion of the rationale and requirements of the provisional restoration in fixed prosthetic dentistry has been presented. The imporatnce of this phase of restorative densitry and a survey of techniques for making interim restorations were gleaned from a review of the literature. A method for the fabrication of a provisional fixed partial denture using an acrylic resin interocclusal record was described and illustrated.