all ceramic cantilever resin bonded bridges: survival and clinical performance

1. FIFTEEN-YEAR SURVIVAL OF
ANTERIOR ALL-CERAMIC CANTILEVER
RESIN-BONDED FIXED DENTAL
PROSTHESES
Matthias Kern
Journal of Dentistry 56 (2017) 133–135
AAMIR ZAHID GODIL
FIRST YEAR P.G.
DEPARTMENT OF PROSTHODONTICS
M.A.R.D.C.

2. OUTLINE
• CANTILEVER FIXED DENTAL PROSTHESES
• RESIN BONDED FIXED DENTAL PROSTHESES
– INDICATIONS, CONTRAINDICATIONS, ADVANTAGES,
DISADVANTAGES, CLASSIFICATION
• CLINICAL PROCEDURE FOR RECEIVING A CANTILEVER
RESIN BONDED FIXED DENTAL PROSTHESIS
• REVIEW OF LITERATURE
• CONCLUSION AND CRITIQUE

3. CANTILEVER FIXED DENTAL
PROSTHESES
According to GPT:
A fixed dental prosthesis
in which the pontic is
cantilevered, i.e. is
retained and
supported only on
one end by one or
more abutments

4. WHEN CAN SUCH CIRCUMSTANCES OCCUR?
• When, for aesthetic reasons, it is not
desirable to prepare the teeth on both sides of
the breach
• When there are no teeth on one side of the
breach
• When one of the abutment teeth is already
supporting another prosthetic restoration

5. RESIN-BONDED FIXED DENTAL
PROSTHESES
• A fixed dental prosthesis that is luted to
tooth structures, primarily enamel, which
has been etched to provide mechanical
retention for the resin cement.
• Early design incorporated perforations on
the lingual plate (Rochette Bridge) through
which the resin bonded material passed to
achieve a mechanical lock; subsequently,
use of acid etching of the metal plate
(Maryland Bridge) eliminated the need for
perforations.
Rochette AL. Attachment of a splint to enamel of lower anterior teeth. The Journal of prosthetic dentistry. 1973 Oct 1;30(4):418-23.

6. INDICATIONS OF RBFDP
REPLACEMENT OF
MISSING ANTERIORS
ABUTMENTS WITH
SUFFICIENT ENAMEL
TO AID ETCHING
SHORT SPAN
BRIDGES
SPLINTING
PERIODONTALLY
WEAK TEETH
MEDICALLY
COMPROMISED
PATIENTS
LONG TERM
TEMPORARY
RESTORATION IN
PATIENTS WITH
CRANIOFACIAL
ANOMALIES
POST-ORTHODONTIC
RETENTION

7. CONTRAINDICATIONS OF RBFDP
INSUFFICIENT
OCCLUSAL
CLEARANCE
THIN ANTERIOR TEETH
FACIOLINGUALLY
SHORT CLINICAL
CROWNS
WHEN FACIAL
ESTHETICS OF TEETH
REQUIRE CHANGE
DEEP VERTICAL
OVERLAP
INSUFFICIENT ENAMEL
AVAILABLE FOR
BONDING:
CARIES/ RESTORATION/
HYPOPLASIA
PARAFUNCTIONAL
HABITS
LONG SPAN BRIDGES
SENSITIVITY TO BASE
METAL ALLOYS

8. ADVANTAGES OF RBFDP
CONSERVATION OF
TOOTH
STRUCTURE
TOLERANT TO
TISSUES WITH NO
PULPAL TRAUMA
AND SUPRA-
GINGIVAL MARGINS
LESS CHAIRSIDE
TIME
DOES NOT
REQUIRE CAST
ALTERATIONS OR
REMOVABLE DIES
REDUCED COST
REBONDING
POSSIBLE

9. DISADVANTAGES OF RBFDP
TECHNIQUE
SENSITIVE
SPACE, CONTOUR
AND ALIGNMENT
CORRECTION OF
ABUTMENT NOT
POSSIBLE
POSSIBILITY OF
OVER-CONTOURING
IS HIGH WHICH CAN
LEAD TO INCREASED
PLAQUE
ACCUMULATION
CAN BE USED TO
REPLACE ONLY ONE
TOOTH
CAN CAUSE GREYING
IN THIN TEETH
ESTHETICS IS
MODERATE

10. CLASSIFICATION OF RBFDP
• MECHANICAL
ROCHETTE
BRIDGE
• MICROMECHANICAL
MARYLAND
BRIDGE
• MACROMECHANICAL
VIRGINIA
BRIDGE
CAST MESH FPD
• CHEMICAL
ADHESIVE
BRIDGES

11. ROCHETTE BRIDGE
(MECHANICAL BONDING)
Use of ring like retainers ,
with funnel shaped
perforations through them to
enhance resin retention.
THE PERFORATION TECHNIQUE PRESENTS THE FOLLOWING
LIMITATIONS:
1. Weakening of the metal retainer by the perforations.
2. Exposure to wear of the resin at the perforations.
3. Limited adhesion of the metal provided by the

12. MARYLAND BRIDGE
(MICROMECHANICAL BONDING)
• An electrolytic etching procedure for non-precious
ceramic bonding alloys to provide a microporous
surface that allows micromechanical interlock with the
cement
• Thinner wings and no perforations

13. VIRGINIA BRIDGE
(MACROMECHANICAL BONDING)
This was a time saving method and more
retention is achieved compared to the
• Roughned surface of the
retainer itself provides for
retention
• Achieved by lost salt
technique.
• Air abrasion with aluminium
oxide.

14. CAST MESH FIXED BRIDGE
(MACROMECHANICAL BONDING)
• A net like nylon mesh is
placed over lingual surface of
abutment teeth on the cast
• It is then covered by wax,
with the undersurface of the
retainer becoming mesh like
when retainer is cast.

15. • It incorporates both perforations and etching of
metal.
• The perforated type can be etched on the tooth
side of metal retainer to provide microscopic
undercuts for added retention.
• This is especially important in areas where
perforations cannot be placed.
SOCKWELL BRIDGE
(MECHANICAL- CHEMICAL BONDING)

16. CLINICAL PROCEDURE
FOR RECEIVING A CANTILEVER RESIN BONDED FIXED DENTAL
PROSTHESIS

17. Missing lateral incisor to be replaced. Removable wax-up during intraoral try-
in.
Preparation of the left central incisor
as abutment (with leftover color
marking).
RBFDP with colored bonding surface
(blue) and provisional resin coating
(red).
RBFDP after air-abrasion of the
retainer wing
Sasse M, Kern M. All-ceramic resin-bonded fixed dental prostheses: treatment planning, clinical procedures, and outcome. Quintessence Int. 2014 Apr

18. Enamel surface with
rubber dam positioned.
Etching with phosphoric acid. Spreading the phosphate
monomer containing
composite resin on the
retainer wing
Incisal splint for correct positioning
of the RBFDP
RBFDP directly after insertion.A single-retainer zirconia RBFDP
prior to insertion

19. RBFDP after 2 years of clinical
service.
RBFDP after 3 years of clinical
service.
RBFDP after 4 years of clinical
service.

20. REVIEW OF LITERATURE
CLINICAL PERFORMANCE AND LONGEVITY OF CANTILEVER
RESIN BONDED FIXED DENTAL PROSTHESIS

21. Wyatt CC. Resin-bonded fixed partial dentures:
what's new?. Journal-Canadian Dental
Association. 2007 Dec 1;73(10):933.

22. Botelho et al- 2006
Botelho MG, Leung KC, Ng H, Chan K. A retrospective clinical evaluation of two-unit cantilevered resin-bonded fixed partial
dentures. The Journal of the American Dental Association. 2006 Jun 30;137(6):783-8.

23. Botelho et al- 2014
Botelho et al- 2016
Botelho MG, Chan AW, Leung NC, Lam WY. Long-term evaluation of cantilevered versus fixed–fixed resin-bonded fixed
partial dentures for missing maxillary incisors. Journal of dentistry. 2016 Feb 29;45:59-66.
Botelho MG, Ma X, Cheung GJ, Law RK, Tai MT, Lam WY. Long-term clinical evaluation of 211 two-unit
cantilevered resin-bonded fixed partial dentures. Journal of dentistry. 2014 Jul 31;42(7):778-84.

24. Reviews by Kern et al

25. Single-retainer zirconia ceramic RBFDPs
present an alternative treatment option
offering good esthetics, a minimally
invasive preparation, a high
biocompatibility and can even be used to
treat juvenile patients who do not yet
come into consideration for implant
placement.
No significant influence of the bonding
system used has been detected so far.
Sasse M, Kern M
(2013)
Sasse M, Kern M. CAD/CAM single retainer zirconia-ceramic resin-
bonded fixed dental prostheses: clinical outcome after 5 years.
International journal of computerized dentistry. 2012 Dec;16(2):109-18.
The 5year survival rate was 73.9% in th
e two retainer group and 92.3% in the
single retainer group.
Kern M (2005)
Kern M. Clinical long-term survival of two-retainer and
single-retainer all-ceramic resin-bonded fixed partial
dentures. Quintessence International. 2005 Feb
1;36(2).
ALL CERAMIC RBFDP
Cantilever all cceramic resin bonded
FDPs made from high strength oxide
ceramics present a promising
treatment alternative to two retainer
RBFDPs in the anterior region

26. Cantilevered zirconia ceramic RBFDPs showed promising results with
the survival rate 95.2% and one debonding considered as failure of the
42 anterior RBFDPs evaluated over 6 years
M. Sasse, M. Kern, Survival of anterior cantilevered all-ceramic resin-bonded fixeddental protheses made
from zirconia ceramic, J.Dent. 42 (2014) 660–663.

27. • Anterior all-ceramic cantilever RBFDPs with a single
retainer made from a glass-infiltrated alumina ceramic
showed a clinical outcome which compares well with the
excellent clinical longevity of metal-ceramic cantilever
RBFDPs with a survival rate of 84% after 15 years.
• However, it should be noted that the study on metal-
ceramic cantilever RBFDPs included not only anterior but
also posterior restorations.
• Therefore, the presented data of the current report support
only the use of all-ceramic cantilever RBFDPs for the
replacement of incisors.
M.G. Botelho, X. Ma, G.J.Cheung, R.K. Law,M.T. Tai, W.Y. Lam, Long-term clinical evaluation of 211 two-
unit cantilevered resin-bonded fixed partial dentures, J. Dent. 42 (2014) 778–784.

28. • More recent studies using densely sintered
zirconia as framework material for cantilever
RBFDPs also show excellent medium-term
clinical survival rates of even 100% after 3
to 6 years
M. Sasse, M. Kern, CAD/CAM single retainer zirconia-ceramic resin-bonded fixed dental prostheses: clinical outcome after 5 years, Int. J.
Comput. Dent. 16 (2013) 109–118 .
I. Sailer, C.H. Hämmerle, Zirconia ceramic single-retainer resin-bonded fixed dental prostheses (RBFDPs) after 4 years of clinical service:
a retrospective clinical and volumetric study, Int. J. Periodontics Restor. Dent. 34 (2014) 333–343.
M. Sasse, M. Kern, Survival of anterior cantilevered all-ceramic resin-bonded fixed dental protheses made from zirconia ceramic, J. Dent.
42 (2014) 660–663.
A. Klink, F. Hüttig, Zirconia-based anterior resin-bonded single-retainer cantilever fixed dental prostheses: a 15- to 61-month follow-up,
Int. J. Prosthodont. 29 (2016) 284–286.

29. CONCLUSION
• For replacement of incisors cantilever RBFDPs
have the potential to became a gold standard to
dental implants as they have fewer biological
complications.
• All-ceramic cantilever resin-bonded fixed dental
prostheses for anterior tooth replacement show
excellent longevity.

30. CRITIQUE
• Small sample size (n=22)
• Questionable comparison criteria to
PFM
• Insufficient evidence with different types
of all ceramic RBFDPs

31. Thank You