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A longitudinal clinical study of bonded fixed partial dentures: the first 5 years.

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.

Appointments and Schedules↗

An 11-year reevaluation of resin-bonded fixed partial dentures.

Clinical success of resin-bonded fixed partial dentures is primarily dependent on their long-term retention. Retention rates of resin-bonded prostheses placed in 66 patients treated by three dentists in private practice were evaluated in the present study. Seventy-seven resin-bonded fixed partial dentures were followed over a period of 1 year to 11 years. Thirty (39%) became dislodged, but nine were successfully rebonded; thus there were 21 failures (27%). Prosthesis location and operator expertise minimally influenced the longevity of these restorations, but the luting agents tested in this sample had a profound impact on retention. Debonding rates were excessive for some materials tested, whereas other agents proved to be predictable. Modifications in preparation design that enhanced resistance form were also likely contributors to improved retention rates.

Dental Bonding↗

An alternative orientation of nonrigid connectors in fixed partial dentures.

Nonrigid connectors have been advocated for fixed partial dentures. However, space limitations may require overreduction of the preparation or overcontouring of the retainer to place the keyway within the retainer wall. An inverted orientation of the nonrigid connector can resolve these problems. With this design, the key is attached to the distal surface of the mesial retainer in a dual-abutment fixed partial denture, and the keyway is incorporated in the mesial surface of the pontic. This inverted orientation offers several advantages with few disadvantages.

Dental Abutments↗

Intraoral repair of fiber-reinforced composite fixed partial dentures.

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.

Acrylates↗

The seating of one-piece and soldered fixed partial dentures.

This laboratory study compared the seating of one-piece castings with that of soldered fixed partial dentures. Two investments were investigated, five American Dental Association type III and five metal ceramic alloy fixed partial dentures were made by using the conventional indirect technique. The investing and casting protocol was designed to produce an ideal fit of the individual complete crown abutments, not the fixed partial denture. Independent seating of each retainer provided a baseline measurement for complete seating and was compared with fixed partial denture seating. Fixed partial dentures were then sectioned and reassembled by soldering twice, using a low- and high-expansion investment. Statistical evaluation identified significant differences between the metals and the techniques. Marginal discrepancies with one-piece casting and lower (0.6%) thermal-expansion soldering were clinically unacceptable. A clinically acceptable fit was obtained with the higher (1%) thermal-expansion soldering investment.

Dental Abutments↗

Chewing ability in patients restored with cross-arch fixed partial dentures.

The chewing ability of subjects with cross-arch fixed partial dentures was compared with that of subjects with complete healthy dentitions and complete-denture wearers. Chewing ability was expressed in terms of the number of chewing strokes, chewing time, chewing efficiency, and chewing performance. Almonds were used as the test food. In terms of chewing efficiency, that is, comminution in relation to time, subjects with cross-arch fixed partial dentures exhibited a chewing ability inferior to that of subjects with complete healthy dentition but superior to that of complete denture wearers. However, in terms of chewing performance, which describes the degree of pulverization before the time of swallow, chewing ability in subjects with cross-arch fixed partial dentures was almost as good as in subjects with complete, healthy dentitions and superior to that of complete denture wearers.

Dental Abutments↗

Clinical outcome of glass-fiber-reinforced crowns and fixed partial dentures: a three-year retrospective study.

OBJECTIVE: Glass-fiber-reinforced resin composites for the fabrication of esthetic single crowns and fixed partial dentures have been developed recently. However, little data on the clinical outcome of such restorations have been published. The purpose of this retrospective study was to evaluate the clinical outcome of crowns and fixed partial dentures made from the glass-fiber-reinforced resin composite material Targis/Vectris. METHOD AND MATERIALS: Between 1995 and 1997, 39 patients were treated with 67 single crowns and 83 fixed partial dentures. Twenty-five crowns and 28 fixed partial dentures were cemented with temporary cement, while 42 crowns and 55 fixed partial dentures were cemented with either zinc-phosphate cement or glass-ionomer cement. RESULTS: In September 2001, 57 restorations in 17 patients were still in function. The three-year survival rate calculated according to the Kaplan-Meier method was 58.8% for all restorations. However, after this time, it was 37.5% for crowns and 59.9% for fixed partial dentures cemented with temporary cement, and 55.1% for crowns and 67.9% for fixed partial dentures cemented with zinc phosphate or glass ionomer. The differences between the restoration groups were not statistically significant. CONCLUSION: Glass-fiber-reinforced crowns and fixed partial dentures made with the glass-fiber-reinforced resin composite material Targis/Vectris showed a lower survival rate than that published for metal-ceramic crowns and fixed partial dentures. Therefore, the use of this material for the fabrication of single crowns or fixed partial dentures as permanent restorations cannot be recommended.

Adult↗

Predictable success with resin bonded fixed partial dentures.

The conservative nature of the resin bonded fixed partial denture is the reason it is used. The ability to replace a missing tooth while avoiding aggressive preparation of the abutment teeth is a desirable concept. The use of conservative preparation forms will aid in the long term predictable success of the resin bonded fixed partial denture.

Denture Design↗

Analysis of stress on a fixed partial denture with a blade-vent implant abutment.

Using a two-dimensional finite element method, a study was made that compared the behavior of a model mandibular posterior fixed partial denture constructed on the second premolar abutment and a blade-vent implant imbedded at the site of the second molar with the behavior of a fixed partial denture constructed on the second premolar and second molar abutments. The following were the results: 1. Deflections of the implant fixed partial denture were less than those of the natural tooth fixed partial denture in vertical and inclined loads. 2. Stress concentration was markedly found in the pontic and the mesial and distal parts of the premolar retainer in both restorations and the implant neck in the implant fixed partial denture. 3. In the implant fixed partial denture, stresses induced in the surrounding bone became higher around the posterior abutment and became lower around the premolar retainer than the stresses produced with the natural tooth fixed partial denture. 4. Therefore it was suggested that, to relieve stress to the surrounding bone around the implant abutment, occlusal forces loaded to the implant fixed partial denture have to be more concentrated on the premolar abutment than do forces loaded to the natural tooth fixed partial denture.

Alveolar Process↗

Effects of two preparation designs and pontic distance on bending and fracture strength of fiber-reinforced composite inlay fixed partial dentures.

STATEMENT OF PROBLEM: Joint fractures observed in Targis/Vectris inlay adhesive fixed restorations may be related to the preparation design. PURPOSE: This in vitro study investigated the effects of the proximal tooth preparation design and the pontic distance on the fracture strength and the amount of bending of fiber-reinforced inlay adhesive fixed partial dentures. MATERIALS AND METHODS: Forty extracted premolars and 40 molars were embedded in a PMMA resin to represent a premolar and molar mesiodistal separation distance of 7 mm and 11 mm, respectively. Two preparation designs were used (proximal box and tub-shaped). The sample size was 10 for each group. Fiber-reinforced inlay adhesive fixed partial dentures were fabricated by use of the Targis/Vectris system and luted adhesively to the teeth with Variolink luting agent. A vertical force was loaded to the center of the fixed partial dentures at a crosshead speed of 1 mm/min. The initial bending (mm) prior to fracture was evaluated by measuring the distance the test rod moved from a 10 N preload to fracture. The differences in the mean fracture strength and the average amount of bending as a function of the preparation designs and pontic distances were compared by use of a 2-way analysis of variance (alpha=.05). The specimens were examined optically for the type of failure with a stereomicroscope. The fracture surface of the specimens was examined by scanning electron microscopy, and radiography was used to investigate the surface morphological features at the failure sites and to determine the fracture mode. A chi-square test was used to identify the differences in the debonding rates between the types of preparation designs and the pontic distance (alpha=.05). RESULTS: The mean fracture strength and the standard deviation of the fiber-reinforced inlay retained adhesive fixed partial denture group was 1368+/-212 N for the 7-mm tub group, 885+/-109 N for the 11-mm tub group, 1779+/-317 N for the 7-mm box group, and 1336+/-281 N for the 11-mm box group. The fracture strength was significantly higher in the 7-mm pontic distance (P<.001) and for the box-shaped tooth preparation (P<.001). The amount of bending was significantly greater in the 7-mm pontic distance (P=.025) and the box-shaped tooth preparation (P=.002). Debonding was observed only in premolar teeth and tub-shaped design groups. CONCLUSION: The box-shaped tooth preparation may be considered for restoration of a missing single posterior tooth with fiber-reinforced inlay adhesive fixed partial dentures.

Adhesiveness↗

Accuracy of six elastic impression materials used for complete-arch fixed partial dentures.

1. The accuracy of four types of impression materials used to make a complete-arch fixed partial denture was evaluated by visual comparison and indirect measurement methods. 2. None of the tested materials allows safe finishing of a complete-arch fixed partial denture on a cast poured from one single master impression. 3. All of the tested materials can be used for impressions for a complete-arch fixed partial denture provided it is not finished on one single cast. Errors can be avoided by making a new impression with the fitted castings in place. Assembly and soldering should be done on the second cast. 4. In making the master fixed partial denture for this study, inaccurate soldering was a problem that was overcome with the use of epoxy glue. Hence, soldering seems to be a major source of inaccuracy for every fixed partial denture.

Dental Impression Materials↗

Proximal contour modifications for fixed partial dentures: a clinical report.

An often-neglected aspect of fixed prosthodontics is the contour of the tooth adjacent to the cast restoration. The adjacent surfaces should be surveyed to reveal compatibility with the path of insertion of the restoration. Adjacent contacts may have to be altered to permit the placement of the fixed partial denture and to ensure proper contact size/shape and embrasure size. The need for guide planes on teeth adjacent to fixed partial denture abutments in fixed prosthodontics is described.

Dental Abutments↗

Two-year follow-up study of Procera-ceramic fixed partial dentures.

PURPOSE: The aim of this prospective study was to determine whether a machine-fabricated titanium fixed partial denture veneered with a low-temperature fused porcelain is an acceptable treatment modality. MATERIALS AND METHODS: The study originally included 25 patients with 37 fixed partial dentures of three to seven units, with a total of 151 units including 98 abutments. A clinical examination using the California Dental Association quality evaluation system and radiologic examination and registration of complications was conducted at the time of insertion and after 1 and 2 years. RESULTS: After 2 years, 123 units (including 80 abutments) remained for examination. Twenty-eight units (including 18 abutments) were lost during the follow-up period. The losses were because of drop-out (eight cases), root fracture (two cases), caries (six cases), and periodontitis (two cases). One fixed partial denture fractured after 18 months and was therefore remade. In all, porcelain fractures occurred in two patients, both with severe parafunctional habits. At baseline, the California Dental Association rating system for marginal integrity was "excellent" for 72 abutments and "acceptable" for 26 abutments. At the 2-year follow-up the corresponding rating was "excellent" for 46 abutments, "acceptable" for 30 abutments, and "not acceptable" for four abutments. The latter marginal defects were corrected with restorations. For surface and color the corresponding ratings were "excellent" for 137 units and "acceptable" for 14 units at baseline, and "excellent" for 80 units and "acceptable" for 43 units at the 2-year follow-up. Bleeding index increased from 24% at baseline to 33% after 2 years. CONCLUSION: The study confirms that for an observation period of 2 years, fixed partial dentures made by the Procera method seem to be an acceptable treatment modality. They are a suitable alternative to fixed partial dentures with porcelain fused to high-noble alloys.

Adult↗

Effect of reinforcement methods on the retention of resin-bonded fixed partial dentures using a composite denture tooth as a pontic: in vitro evaluation.

PURPOSE: The incorporation of composite denture teeth as pontics in resin-bonded fixed partial dentures has been deemed to be short-lived. This study investigated whether pre- or posttreatments could improve the bonding of denture tooth pontics. MATERIALS AND METHODS: A model fixed partial denture was fabricated that included composite denture teeth (Endura) bonded with 1 of 2 resin systems (C&B-Metabond or Aeliteflo). The bonding surface of the pontic was pretreated with one of three methods (air-particle abrasion [AA], AA plus silanization, or cavity preparation plus AA). The bonding areas between pontic and abutments were posttreated with 1 of 2 methods (reinforcement with fiber or metal post). Five bonded specimens for each treatment group were subjected to 20,000 thermocycles (40 degrees C to 60 degrees C; dwell time 60 s) before retentive forces (N) were determined. All data were analyzed with two-way ANOVA and Bonferroni's test (p = 0.05). RESULTS: All specimens that underwent the pre- and posttreatment outperformed untreated specimens. For the specimens bonded with C&B-Metabond and posttreated with a polyethylene fiber (Ribbond) or a metal post (DC Post), the mean retentive forces were 316 N and 301 N for mandibular specimens, and 354 N and 380 N for maxillary specimens, respectively. These values were significantly higher than those obtained with other pretreatment methods (p < or = 0.0003). For mandibular specimens bonded with Aeliteflo, specimens posttreated with Ribbond exhibited significantly higher retentive forces (332 N) compared to other specimens (p < or = 0.0001). CONCLUSION: Within the limitations of this study, the bond strength of a resin-bonded fixed partial denture incorporating a composite denture tooth as the pontic was improved by reinforcement with either a polyethylene fiber or a metal post.

Analysis of Variance↗

Biomechanics of cantilever fixed partial dentures in shortened dental arch therapy.

PURPOSE: The purpose of the present study was to investigate, by means of 3-dimensional finite element analysis, aspects of the biomechanics of cantilever fixed partial dentures replacing the maxillary canine in shortened dental arch therapy. The null hypothesis was that no differences would be identified by finite element analysis in the mechanical behavior of the 2 designs of cantilever fixed partial denture under different scenarios of occlusal loading. MATERIALS AND METHODS: Single- and double-abutted cantilever fixed partial dentures were modeled and analyzed using the finite element packages PATRAN and ABAQUS. Displacement and maximum principal stresses (magnitude and location) within the fixed partial dentures, supporting structures, and the periodontal ligament/bone and abutment/retainer interfaces were examined under 20 different scenarios of axial and lateral occlusal loading. RESULTS: The results indicate that more displacement occurred in the 2 rather than the 3-unit cantilever fixed partial denture, with the greatest displacement having occurred under lateral loading. The maximum principal stresses observed in the periodontal ligament/bone interfaces were greatest buccocervically, with the highest value being observed in the 2-unit fixed partial denture under lateral loading. The highest maximum principal stresses observed in the retainer/abutment interfaces were located cervically in relation to the distal margin of the retainer of the 2-unit fixed partial denture under axial loading. CONCLUSIONS: It was concluded that in adopting a cantilever fixed partial denture approach for the replacement of a missing maxillary canine in shortened dental arch therapy, there may be merits, in terms of mechanical behavior, in selecting a double-rather than a single-abutment design. Furthermore, prostheses' displacement and functional stresses may be minimized by reducing lateral loading and avoiding pontic only loading.

Biomechanical Phenomena↗

Effect of pontic height on the fracture strength of reinforced interim fixed partial dentures.

OBJECTIVES: This in vitro study evaluated the fracture load of interim FPDs made with various materials and pontic heights. The hypothesis was that different materials and pontic heights result in different fracture resistance. METHODS: Groups of interim FPDs were fabricated with prosthodontic resin materials on two abutments with two different pontic heights (4.3 and 5.8 mm) and a pontic width of 4 units (19 mm) (n = 3). The following materials were tested: (1) a thermoplastic polymer (Promysan Star), (2) Promysan Star with a veneering composite (Vita Zeta), (3) a non-impregnated polyethylene fiber reinforced resin (Ribbond) with a veneering composite (Sinfony), (4) an impregnated fiber reinforced composite system (Targis/Vectris), and (5) a conventional poly methyl methacrylate (PMMA) (Biodent K+B, control group). After 5000 thermocycles, the FPDs were temporarily fixed with a provisional cement on the corresponding abutments and tested for fracture strength. One-way and two-way ANOVA and Bonferroni-Dunn's multiple comparison tests were performed for the statistical analysis (alpha = 0.05). RESULTS: The mean fracture strength ranged from 83.0 to 625.9 N for a pontic height of 4.3 mm and from 97.2 to 893.7 N for a pontic height of 5.8 mm. Vectris/Targis FPDs of both pontic heights exhibited significantly superior fracture resistance compared to the corresponding Promysan, Promysan/Vita Zeta, Ribbond/Sinfony and Biodent groups. Except Biodent FPDs, fracture resistance of FPDs with a pontic height of 4.3 mm showed no significant differences compared to a pontic height of 5.8 mm for each material. SIGNIFICANCE: Material type of the FPDs has a significant influence on the fracture strength, whereas pontic height has no significant effect (except control group).

Analysis of Variance↗