[Fixed partial denture and abutment teeth].
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Occasionally, clinicians are faced with a situation in which a solitary tooth between two bridges requires extraction. When this type of situation occurs, we must ponder the dilemma of how to replace the missing tooth. Options include placing an implant where the tooth was extracted or remaking one large multiunit bridge. Implants are not always possible or practical, and remaking a multiunit bridge that involves the abutments of the two existing bridges can be challenging and becomes much more expensive to the patients. The overcasting technique is a treatment modality that offers a solution in these particular situations.
Resin-bonded fixed partial dentures (RBFPDs) initially recorded poor survival rates because of indefinite tooth preparations and arbitrary selection of composite resin cements. In this study, 46 RBFPDs were inserted for a longitudinal study up to 45 months. The influence of location--anterior/posterior, or maxilla/mandible--and the inclusion of pontics in occlusal excursions on the survival rates was investigated. Periodontal parameters were recorded from abutments and controls (teeth). Eight RBFPDs lost retention and two RBFPDs failed because of porcelain fractures. The anterior to posterior location and the maxillary or mandibular arch had significant influence on the survival rates. Gingival scores of abutments and controls differed significantly, but statistically significant differences were not recorded for plaque scores.
When a fixed partial denture fails due to recurrent caries under the casting of the abutments, a remake process usually requires a great deal of cooperation, multiple lengthy appointments, and financial resources. Many patients with special needs may not have the cooperation, tolerance, and resources to support such treatment. This paper describes an alternative method that utilizes a chemomechanical system for caries removal followed by a conventional restorative material to treat those patients.
STATEMENT OF PROBLEM: It is important to evaluate the long-term clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses. PURPOSE: A prospective, long-term clinical study was conducted to evaluate the success of resin-bonded fixed partial dentures since 1985 and of resin-bonded extracoronal attachments from 1987. METHODS: Until 1993, a total of 130 resin-bonded fixed partial dentures had been seated in 101 patients, as well as 12 removable partial dentures (RPDs) with 24 extracoronal retainers in 10 patients. The clinical treatment protocol and the laboratory procedures were standardized. By the end of 1993, it was possible to reexamine 98 patients with a total of 127 resin-bonded fixed partial dentures and all 10 patients with removable partial dentures. The average time in function for the resin-bonded fixed partial dentures at the time of examination was 3.4 years and 2.3 years for the removable restorations. RESULTS: During the period of observation, one retainer failed on six of the resin-bonded fixed partial dentures, which represents a failure rate of 4.7%. Debonding of extracoronal attachments was recorded for 8.3% of the total number of retainers. CONCLUSION: The resin-bonded fixed partial denture technique can be considered to be a clinically reliable method of treatment, and permits the expansion of indications beyond a classical three-unit resin-bonded fixed partial denture. Long-term clinical success of removable partial dentures with resin-bonded extracoronal retainers warrants additional clinical studies.
The influence of end abutment and cantilever fixed partial dentures on periodontal health was examined in 12 patients with periodontally reduced residual dentition. The prosthetic appliances had been integrated for 4 to 6 years before the first follow-up examination and had no technical defects at baseline. Two follow-up examinations were performed at a 12-month interval to record clinical and microbiologic parameters of 62 abutment teeth, 45 of which were fitted with end abutment fixed partial dentures and 17 with cantilever fixed partial dentures. Both types of fixed partial dentures were represented in all patients. The patients were on a 6 to 8-week recall schedule throughout the study period and had good oral hygiene. At both examinations, subgingival plaque samples were taken at all proximal surfaces and evaluated by dark-field microscopy. The clinical parameters used were Gingival Index, Plaque Index, pocket probing depth, and attachment level. The results showed that both types of fixed partial dentures were compatible with periodontal health subject to optimal oral hygiene. The clinical parameters recorded remained stable at a very low level throughout the study period and were almost identical in both groups. A slight gain in clinical attachment level, with a mean value of 0.19 mm for abutment teeth fitted with cantilever fixed partial dentures and of 0.32 for end abutment fixed partial dentures, was registered during the study period. The composition of the subgingival plaque showed a microflora reflecting virtually health periodontal conditions. The proportion of motile rods and spirochetes was slightly elevated in both groups. In conclusion, it can be stated that both fixed partial denture types display identical characteristics in the periodontally damaged dentition and do not lead to deterioration of the periodontal situation if oral hygiene is closely monitored.
The clinical performance of 325 resin-bonded fixed partial dentures (RBFPD) placed between 1984 and 1995 was reviewed. The primary indications of the 264 patients treated were trauma and aplasia. Two hundred eighty-three of the resin-bonded fixed partial dentures were primary restorations, and 42 of the restorations were secondary and tertiary after the loss of the primary resin-bonded fixed partial denture. Including the rebonded restorations, the survival rate calculated using the Kaplan-Meier method was 76% after 5 years and 60% after 10 years. Analysis of the data showed that casting alloy, pretreatment of the bonding surfaces, luting agent, and mobility of the abutment teeth were decisive prognostic factors for success. Base metal alloys, silicoating, mesh retention, and immobile abutments were positive factors. In contrast to other reports in the literature, retentive abutment preparation did not result in a higher survival rate than unprepared abutments. Small restorations in the bonding area did not affect the survival. No differences in survival rate were found for resin-bonded fixed partial dentures in the maxillae or mandible, or in the anterior and posterior regions. Multiunit resin-bonded fixed partial dentures had a smaller probability of survival than three-unit resin-bonded fixed partial dentures. Carious lesions were found on 4% of the abutment teeth.
OBJECTIVES: This in vitro study tested the influence of diverse stress simulation parameters on the fracture strength of all-ceramic three-unit fixed partial dentures (FPDs). METHODS: All-ceramic FPDs made of Empress 2 (Ivoclar-Vivadent, FL) were exposed to thermal cycling and mechanical loading (TCML) with varying loading parameters such as chewing force (amount, frequency), thermal loading, lateral jaw motion, abutment material, artificial periodontium or antagonistic denture. To investigate the influence of the abutment material, human teeth, polymer abutments and alloy abutments were used. Two different TCML devices with pneumatic or weight loading were compared. FPDs without aging were used as a control. RESULTS AND SIGNIFICANCE: Combined thermal and mechanical loading significantly reduced the FPD fracture resistance from 1832N to 410N. Duplication of chewing frequency, phase load increase or additional lateral movement did not effect the results. Increasing chewing force, artificial periodontium, and antagonist or abutment material reduced the fracture resistance of the tested FPDs. Different devices with weight or pneumatic loading had no significant influence on the loading capacity of the FPDs. Artificial aging should be performed combining thermal cycling with mechanical loading. Simulation of the artificial periodontium, human antagonists and abutments should be included to achieve a significant aging.
STATEMENT OF PROBLEM: Long-span fixed partial dentures usually require splinting of multiple abutments to overcome mechanical problems associated with the long edentulous span. Most information and indications for the use of multiple splinted abutments have been empirically derived. PURPOSE: This study analyzed the stress levels in the teeth and supporting structures of a fixed prosthesis and ascertained how the addition of multiple abutments in a fixed prosthesis modifies the stresses and their deflection. MATERIAL AND METHODS: The finite element method was used to analyze mechanical behaviors of a prosthesis and its supporting structures when a fixed prosthesis with several designs replaced a mandibular second premolar and a first molar. Variations of the standard finite element model were made by changing the number of splinted teeth and the level of bone support. RESULTS: A reduction of stress and deflection was observed in the supporting structures when a fixed partial denture was fabricated and teeth were splinted together. Increasing the number of splinted abutments did not reveal a proportional reduction of stress in the periodontium. Stress concentrations were seen in the connectors of prosthesis and in the cervical dentin area near the edentulous ridge. CONCLUSION: Increasing the number of the splinted abutment did not compensate for the mechanical problems of a long-span fixed partial denture sufficiently.
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When a resin-bonded fixed partial denture is planned in the maxillary anterior region, special attention must be paid to occlusal diagnosis. Specific instrumental diagnosis is necessary to define the functionally important factors: the anterior teeth, the occlusal plane, the temporomandibular joint, and their three-dimensional relation. The optimal treatment in an anterior-guided occlusion is a complete integration of the retainers in the given tooth form without altering the original inclination of the palatal guiding surfaces of the anterior teeth. In many cases, preprosthetic orthodontics is indicated because of functional and esthetic reasons. The objective is to achieve an anterior tooth position that allows the retainers of a resin-bonded fixed partial denture to be incorporated with the designed inclination of the guiding surfaces, using noninvasive preparation techniques. Preprosthetic orthodontic treatment planning, possible problems, and limiting factors as well as the subsequent prosthetic reconstruction have been described in detail. The interdisciplinary treatment has to be planned individually for each patient, depending on the functional diagnosis and the clinical and anatomic situation.
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Etched-metal, composite resin-bonded, fixed partial dentures, as described in the early 1980s, gained an immediate application and popularity in restorative dentistry. This initial report presents the results of the first 5 years of a 10-year longitudinal study of these restorations. A total of 71 fixed partial dentures, ranging in use from 13 to 65 months, that were placed at the University of California, Los Angeles, School of Dentistry using consistent design parameters and restorative techniques have been analyzed. The results of this initial report indicate: (1) bonded fixed partial dentures are technique-sensitive; (2) optimal success requires meticulous attention to procedural detail; (3) anterior bonded fixed partial dentures do not appear to need routine 180-degree-plus circumferential retainer preparation for predictable success; (4) posterior bonded fixed partial dentures appear to require 180-degree-plus circumferential preparation for predictable success; (5) for single-tooth posterior replacements or single-to-double tooth anterior replacements, bonded fixed partial dentures are a viable alternative to conventional fixed partial dentures when intact abutments exist; and (6) most failures occurred within the first year.
STATEMENT OF THE PROBLEM: Fractured composite facings may result in replacement of a fixed partial denture unless a reliable intraoral repair method can be provided. PURPOSE: This in vitro study tested the quality of an intraoral repair method for fractured facings of fixed partial dentures made of a fiber-reinforced composite system. MATERIAL AND METHODS: Shear bond strengths of a light-curing composite to a fiber-reinforced composite material were determined after different mechanical surface treatments. Aluminum oxide air abrading provided the most reliable bond strength values and therefore was used as a pretreatment for the facing repair of three-unit posterior fixed partial dentures. Facing repair was performed with the tested light-curing hybrid composite. Facing fracture strengths of repaired and original fixed partial dentures were determined after thermocycling and mechanical loading. RESULTS: Median facing fracture strength of the original fixed partial dentures was 1450 N after a simulated clinical service of 5 years. Facing fracture strengths of the repaired fixed partial dentures were significantly lower compared with the control group after an additional simulated 2-year interval. However, the median fracture force was still 1000 N. CONCLUSIONS: The facing repair of a fiber-reinforced fixed partial denture with a hybrid composite in combination with aluminum oxide air-abrading pretreatment and silanization provided sufficient fracture strength. Therefore the replacement of the complete restoration may be avoided.
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