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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↗

Measurement of distortions in fixed partial dentures resulting from degassing.

1. During the degassing phase, fixed partial dentures removed immediately when the temperature reached 1,900 degrees F (1,038 degrees C) with soldered connectors do not distort more than those with cast connectors. While not tested, heat-soaking could be expected to cause a greater amount of distortion, especially for fixed and supported partial dentures having soldered connectors. 2. Use of custom-made sagger trays giving support to long-span fixed partial dentures at the ends and within the span is desirable for both degassing and porcelain firing, regardless of whether or not the connectors are cast or soldered. 3. The accumulative amount of possible distortion resulting from soldering, degassing, and porcelain firing may be clinically significant if precautions are not affected.

Dental Instruments↗

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↗

Intrusion of teeth in the combination implant-to-natural-tooth fixed partial denture: a review of the theories.

This article reviews the literature dealing with the combination implant-to-natural-tooth-supported fixed partial denture. The restoration of masticatory function with a combination implant-to-natural-tooth fixed partial denture is associated with a variety of undesirable clinical sequelae, including the breakage of implant components, damage to the abutment teeth, or intrusion of the abutment teeth. Theories regarding intrusion of abutment teeth combined with implants for fixed partial dentures are only speculative. Several theories are presented to explain the intrusion of natural teeth in association with implant-to-natural-tooth fixed partial dentures. One of the first theories was based on the idea that a lack of normal stimulation of the periodontal ligament produces atrophy of the periodontal ligament and intrusion of the tooth. The remaining theories relate to excessive forces being placed on the natural tooth, resulting in movement of the tooth to a less stressful position. These forces are placed on the tooth by differential energy dissipation, mandibular flexion and torsion, flexion of the fixed partial denture framework, impaired rebound memory, debris impaction or microjamming, or ratchet effect related to the use of precision attachments. Based a review of the literature, a philosophy for treating combination implant-to-natural-tooth restorations is presented.

Biomechanical Phenomena↗

Patients' perceptions of esthetics and technical quality in crowns and fixed partial dentures.

To assess patients' perceptions of different types of fixed anterior restorations, their responses to (1) metal-ceramic versus all-ceramic restorations; (2) National Health Service versus private-contract metal-ceramic restorations; and (3) normal versus overbuilt metal-ceramic restorations were compared. More people thought the all-ceramic crowns were more natural and preferred those restorations. More people thought the metal-ceramic fixed partial dentures were more natural, and those were also preferred. For both crowns and fixed partial dentures, respondents thought the private work was more natural looking, but the National Health Service work was preferred for the crowns. Respondents thought the crowns and fixed prostheses with normal margins were of a higher technical standard, and those restorations were preferred. The shade and color of the restorations were the most important factors in the patients' assessments.

Adult↗

Success rate and failures for fixed partial dentures after 20 years of service: Part I.

PURPOSE: The objective of this study was to identify failures and to assess rate for fixed partial dentures constructed 20 years earlier by general practitioners in Sweden. MATERIALS AND METHODS: The original group consisted of 164 patients who had received prosthodontic treatment in 1974 comprising fixed partial dentures with at least five units. They had all been selected at random from the files of the Swedish Federal Dental Insurance Register. Twenty years later, 98 of them could be located and 72 of them agreed to participate in a clinical examination. The majority of drop-outs of the original group had died, could not be traced, or could not participate because of medical reasons. The examination focused on removed prostheses and/or units and a number of other clinically valid variables that will be reported in a forthcoming article. The 26 patients not participating in the clinical examination were interviewed by telephone. RESULTS: The examined participants had a total of 140 fixed partial dentures, 557 retainers, and 383 pontics still in service. When the number of failed and removed prostheses was calculated, a cumulative success rate of 65% was found, i.e., one third had been lost since 1974. There was no difference in failures between fixed partial dentures with or without cantilevers during the previous 8 years compared to the first 12 years in service. Loss of retention together with periodontal and esthetic problems, wear, and discoloration of acrylic veneers were the most frequently reported reasons for removal. CONCLUSIONS: The cumulative success rate for fixed partial dentures placed in 1974 was 65%. Failed prostheses had in most cases been replaced by a new fixed partial denture.

Adult↗

In vitro fracture resistance of posterior metal-ceramic and all-ceramic inlay-retained resin-bonded fixed partial dentures.

STATEMENT OF PROBLEM: Inlay-retained resin-bonded fixed partial dentures (RBFPDs) are conservative prosthetic restorations; however, their resistance to fracture is not clear. PURPOSE: The purpose of this study was to compare fracture loads of posterior complete coverage metal-ceramic restorations with all-ceramic inlay-retained RBFPDs. MATERIAL AND METHODS: Thirty-two posterior ceramic RBFPD restorations were divided into 4 groups (n=8): (1) Complete metal-ceramic fixed partial dentures (MC-FPDs) fabricated of Ni-Cr-based alloy (Wirolloy) and veneered with a ceramic (IPS d.SIGN) as the control group; (2) inlay-retained metal-ceramic (MC RBFPDs) with the same materials as the control; (3) inlay-retained lithium disilicate (LD) glass-ceramic (IPS Empress 2) RBFPDs; and (4) inlay-retained zirconia-based (Z) ceramic (Cercon) RBFPDs. Control specimens were prepared to receive conventional complete MC-FPDs designed to include a 1.3-mm-circumferential, 90-degree flat shoulder with rounded angles. Inlay-retained RBFPD specimens were prepared with 2-mm occlusal reduction but without bevels at the occlusal or gingival margins. Specimens were loaded and fracture loads (N) measured at fracture with a universal testing machine at a crosshead speed of 1.0 mm/min and 250 kgf load cell. Data were analyzed with 1-way ANOVA and Duncan test (alpha=.001). RESULTS: Fracture loads (mean +/- SD) were greatest for control specimens (1318.43 +/- 211.00 N) and Z-RBFPD (1247.70 +/- 262.51 N) specimens as compared to MC-RBFPD or LD-RBFPD (P < .001). MC-RBFPD exhibited the next highest fracture loads (958.01 +/- 194.29 N), and LD-RBFPD exhibited the significantly lowest values (303.23 +/- 92.54 N) of the materials tested (P < .001). CONCLUSION: Inlay-retained zirconia-based ceramic RBFPDs demonstrated the greatest fracture resistance among all inlay-retained restorations tested.

Ceramics↗

The fit of fixed partial dentures joined by infrared soldering.

This study determined the accuracy of fit of three-unit fixed partial dentures joined by an infrared soldering technique compared with one-piece fixed partial denture castings and individually cast crowns. Wax patterns of prepared Ivorine teeth, maxillary left central incisor and maxillary left canine, were injection molded; a plastic rod was used as a pontic. One group of patterns was cast as one-piece dentures; the other group was sectioned in the connector area, cast individually and then joined by infrared soldering. Castings were seated on their respective dies, embedded in epoxy resin, and sectioned. Gap distances between the casting and the die were measured at specified marginal sites with a profile projector. Results showed that the fit of infrared-soldered fixed partial dentures was significantly better than that of one-piece castings and was comparable with the fit of single crowns. The gap openings measured in all castings were within the range of clinical acceptability.

Crowns↗

Influence of cold working and thermal treatment on the fit of implant-supported metal-ceramic fixed partial dentures.

STATEMENT OF PROBLEM: The application of porcelain may alter the fit of metal-ceramic frameworks. In fixed partial denture frameworks, this altered fit may cause marginal opening and require sectioning and soldering of the prosthesis. PURPOSE: The purpose of this study was to compare the fit of implant-supported metal-ceramic fixed partial dentures when different thermal treatments were performed. MATERIAL AND METHODS: Fifteen implant-supported metal-ceramic fixed partial denture frameworks were fabricated and divided into 3 treatment groups: Group 1 = cold working and thermal oxidation; Group 2 = unrestrained thermal treatment, cold working, and oxidation; and Group 3 = investment-restrained thermal treatment, cold working, and oxidation. After the appropriate treatment procedures, porcelain was applied. Measurements were made with a digital caliper, with the help of fiduciary marks, after each step in 3 dimensions and at 2 locations. These measurements were compared with those of the as-cast framework (baseline) to determine framework distortion. Distortion data among groups were compared with repeated-measures analysis of variance and Tukey's Studentized range test (P<.05). RESULTS: Absolute values of distortion (regardless of direction) after thermal treatment and after porcelain application were not significantly different among groups. However, total raw values of distortion, which describe the specific direction of distortion, were significantly different for 4 of the 6 recorded measurements between Groups 1 and 3 (P<.05). Although the absolute distortion values did not differ among groups, heat treatment and finishing of the alloy affected the timing and direction of distortion. CONCLUSION: Within the limitations of this study, heat treatment of implant-supported metal-ceramic fixed partial denture frameworks before cold working did not decrease the total absolute distortion. Definite patterns of distortion were, however, found in Groups 1 and 3, suggesting that specific manipulations and heat treatments of the alloy affected the direction of distortion.

Analysis of Variance↗

[Application of bolt-like casting post in posterior fixed partial denture].

OBJECTIVE: To study the manipulation procedure and application of a new post-core system in posterior fixed partial dentures. METHODS: Abutment tooth canals were firstly prepared according to respective canal directions and then complete crown preparation was made following standard procedures. The impression of prepared abutment teeth was taken with silicone and specially made syringe. The fixed partial denture and bolt-like post were fabricated respectively and lastly the two parts were glued together in patient after try-in. RESULTS: All the fixed partial denture with the new post-core system did not get loose and there was no abutment tooth fractured after 23 months in use. CONCLUSIONS: This new post-core system could improve retention of the posterior fixed partial denture if the inter-occlusion distance of the abutment tooth was shorter than 3 mm.

Dental Abutments↗

Fracture surface analysis of clinically failed fixed partial dentures.

Ceramic systems have limited long-term fracture resistance, especially when they are used in posterior areas or for fixed partial dentures. The objective of this study was to determine the site of crack initiation and the causes of fracture of clinically failed ceramic fixed partial dentures. Six Empress 2 lithia-disilicate (Li(2)O x 2SiO(2))-based veneered bridges and 7 experimental lithia-disilicate-based non-veneered ceramic bridges were retrieved and analyzed. Fractography and fracture mechanics methods were used to estimate the stresses at failure in 6 bridges (50%) whose fracture initiated from the occlusal surface of the connectors. Fracture of 1 non-veneered bridge (8%) initiated within the gingival surface of the connector. Three veneered bridges fractured within the veneer layers. Failure stresses of the all-core fixed partial dentures ranged from 107 to 161 MPa. Failure stresses of the veneered fixed partial dentures ranged from 19 to 68 MPa. We conclude that fracture initiation sites are controlled primarily by contact damage.

Compressive Strength↗

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↗

Meta-analysis of fixed partial denture survival: prostheses and abutments.

STATEMENT OF PROBLEM: Few estimates of the probability of various outcomes associated with replacement of missing teeth with fixed partial dentures have been reported. Existing longitudinal studies have reported widely disparate results for the survival of fixed partial dentures, but these studies have used different definitions of failure and varying periods of follow-up. PURPOSE: This study used meta-analysis to formulate annual probability estimates for three categories of fixed partial denture or abutment survival. METHODS: A systematic review of the English language literature since 1960 identified eight studies that met the preset inclusion criteria. Estimated annual survival proportions were back-calculated based on the Kaplan-Meier model and these proportions were combined through a fixed effects model meta-analysis. The probabilities and corresponding 95% confidence intervals at 5, 10, and 15 years for the three categories of survival are reported. RESULTS: For the aggregate population represented by the limited longitudinal studies available, this meta-analysis indicated that less than 15% of fixed partial dentures were removed or in need of replacement at 10 years; whereas, nearly one third were removed or in need of replacement at 15 years. Less than 5% of abutments were removed at 10 years.

Confidence Intervals↗

The mechanical behaviour of cantilever fixed partial dentures in shortened dental arch therapy: a 2-D finite element analysis.

In the present study two-dimensional finite element models of two- and three-unit cantilever fixed partial dentures were created to simulate the replacement of a maxillary second premolar in a shortened dental arch. The purpose of the study was to investigate the mechanical behaviour of the two designs of fixed partial denture using the finite element method. The results indicate that the mechanical behaviour of the three-unit fixed partial denture was more favourable than that of the two-unit fixed partial denture under similar conditions of occlusal loading. Prosthesis displacement and maximum principal stresses increased substantially when loading was limited to the pontic, in particular, in the model of two-unit fixed partial denture.

Bicuspid↗

Photoelastic stress analysis in a pier retainer of an anterior resin-bonded fixed partial denture.

STATEMENT OF PROBLEM: A clinical situation may arise with 2 edentulous spaces and a single intact pier tooth. A dentist may restore these edentulous spaces with a long span resin-bonded fixed partial denture using the pier and the 2 terminal abutments for bonding. PURPOSE: This study analyzed the stresses induced in a pier retainer of an anterior resin-bonded fixed partial denture and determined the effect on a pier abutment. MATERIAL AND METHODS: Photoelastic materials were selected to represent the relative stiffness of 3- and 5-unit resin-bonded fixed partial dentures. The models were scaled to x2.5 to enhance visual analysis of the stress pattern. RESULTS: Isochromatic fringes indicated a stress magnitude at the proximolingual areas of the pontic in the 3-unit resin-bonded fixed partial denture. In the 5-unit resin-bonded prosthesis, the stress pattern appeared to involve the entire surface of the pier retainer. CONCLUSION: The use of pier abutments should be avoided and it is more favorable to use 3-unit resin-bonded fixed partial dentures.

Dental Abutments↗