various unconventional fixed partial dentures in dentistry

1. UNCONVENTIONAL FIXED
PARTIAL DENTURES
Eesha Mody
II MDS
SRM DENTAL COLLEGE, CHENNAI

2. INTRODUCTION
• The dental arch is in a state of dynamic equilibrium
with the teeth supporting each other. When a tooth is
lost, the structural integrity of the dental arch is
disrupted and there is a subsequent realignment of
teeth until a new state of equilibrium is achieved.
Hence, it is very essential to replace this lost tooth as
early as possible. This can be achieved with the help
of a fixed partial denture.

3. • Fixed dental prosthesis: Any prosthesis that is fixed to a natural tooth or teeth, or to one or more
dental implants/implant abutments and that which cannot be removed by the patient.
-GPT 9

4. CLASSIFICATION OF VARIOUS BRIDGE DESIGNS
Bridgedesigns Conventional
bridges
Resin retained
Combination
Design variations for
special situations
Implant retained
fixed prosthesis
Madhok S, Madhok S. Evolutionary changes in bridge designs. IOSR J Dent Med Sci. 2014;13(6):50-6.

5. • Based on the type of support provided at each ends of the pontic:
Fixed-fixed
Cantilever bridge
Spring cantilever
bridge
Smith ED, Howe LC. Planning and making crowns and bridges. CRC Press; 2013 Oct 5, pg 197-203
Conventional bridge design

6. 1. Rigid connector on both ends of the pontic
2. This design provides desirable strength and stability to the prosthesis
3. Abutment teeth parallel to each other so that the bridge can be cemented in one piece.
4. To prevent uplifting of the fdp from one side of the abutment, the occlusal surface of the
abutment teeth should be covered by retainers.
Fixed-fixed bridge

7. Advantages
Disadvantages
1. Maximum retention and
strength.
2. Abutment teeth are splinted
together.
3. Ease of fabrication
1. More tooth reduction is
required.
2. Needs to be cemented
in one piece
3. Cannot be used in tilted
abutments

8. 1. Provides rigid support for the pontic at one end only.
2. The pontic may be attached to a single retainer or to two or more retainers splinted together,
but has no connection at the other end of the pontic.
3. There should be light occlusal contact with absolutely no contact in excursions.
4. The abutment tooth maybe mesial or distal to the span, but for small bridges its mostly distal.
5. Ideal cantilever situations are lateral incisor replaced with canine support and first premolar
replaced with second premolar (primary abutment) and first molar (secondary abutment)
Cantilever bridge

9. Advantages:
1. Most conservative design.
2. Ease of fabrication.
3. Suitable for replacing
anterior teeth.
4. Easier maintenance and
cleaning
Disadvantages:
1. Construction of the bridge
must be rigid to avoid
distortion.
2. Cannot be used on posterior
teeth.

10. 1. It is a tooth and tissue supported bridge
2. Used for the replacement of a maxillary central incisor.
3. Only one pontic can be supported by a spring cantilever bridge. This is attached to the end of a
long metal arm running high into the palate and then sweeping down to a rigid connector on
the palatal side of a single retainer or a pair of splinted retainers.
4. The arm is long and thin so that it is springy, but not so thin that it would deform permanently
under normal occlusal forces
Spring Cantilever
bridge

11. • These are minimal preparation bridges for resin retention luted to
tooth structure, primarily enamel which has been etched to provide
micromechanical retention for the resin cement.
Resin retained bridges
Madhok S, Madhok S. Evolutionary changes in bridge designs. IOSR J Dent Med Sci. 2014;13(6):50-6.
Resin bonded retainers
Mechanism of
attachment of retainer
to the abutment
Little or no removal of
tooth structure
Properties
of the
bonding
resin
Design of
the
framework
Bonding
technique

12. Objective: Cover as much enamel as possible without
compromising occlusion, esthetics and periodontal health.
Mechanical retention, micromechanical retention,
macroscopic mechanical and chemical retention
Weakest link: Bond between the framework and resin.

13. • Indications
Replacement of
anterior teeth in
children and
adolescents
Short edentulous span
Unrestored abutments
Single posterior tooth
replacement
Significant C:R length

14. • Contraindications
Parafunctional
habits
Long
edentulous
span
Restored or
damaged
abutments
Compromised
enamel
Deep vertical
overlap
Nickel allergy Pontic width
discrepancy

15. 1. Rochette bridge
Rochette AL. Attachment of a splint to enamel of lower anterior teeth. The Journal of prosthetic dentistry. 1973 Oct 1;30(4):418-23.
• Developed in 1973 by Rochette.
• He used the technique principally for periodontal splinting mandibular
anterior teeth and also used pontic in his design.
Wing like retainers along
with perforations to
enhance retention

16. Livaditis GJ. Cast metal resin-bonded retainers for posterior teeth. Journal of the American Dental Association (1939). 1980 Dec;101(6):926-9.
In 1980, Livaditis modified the rochette bridge to be used
for posterior teeth.
Posterior
retainer
Occlusal
rest
Lingual
segment
Proximal
segment

17. • Prevents displacement of the restoration in a
gingival direction during trial insertion and final
bonding.
• Assists in transferring the occlusal forces to the
abutment tooth
• Approximately 1 mm in diameter and 0.5 mm deep.
• The margin of the framework is located
supragingivally.
• When it is necessary to terminate the
framework near the gingiva, the margin of the
retainer must be well adapted with a knife-edge
finish line
• The general objective is to obtain maximum
coverage for a greater bond.
• The framework should extend well beyond the
contact area toward the proximofacial line angle.
• This slight “wrap-around” design will provide
considerable stability in a faciolingual direction
• The proximal segment should provide an
adequate connector area for pontics without
impinging on the soft tissues.

18. Disadvantages:
1. Weakening of the metal retainer
by perforations
2. Limited adhesion
3. Wear of composite resin
4. Thick lingual retainers
5. Plaque accumulation

19. 2. Virginia bridge
• In 1983 Moon and Knap developed a roughened metal surface by using salt crystals to create
voids in self-curing acrylic resin patterns.
• In 1985 Hudgins used the lost salt technique for the fabrication of resin bonded metal retainers
giving the framework macroscopic mechanical means of retention with the resin cement
Hudgins JL, Moon PC, Knap FJ. Particle-roughened resin-bonded retainers. Journal of Prosthetic Dentistry. 1985 Apr 1;53(4):471-6.

20. Technique
Working cast
with lubricant
specially sized
salt crystals (150–
250µm) are
sprinkled leaving
0.5mm border
Application of
wax pattern
Salt is dissolved
before investing
to give a rough
surface for resin
tag formation

21. Another method involves the use of a mesh pattern with a design similar to woven screen wire.
Taleghani M, Leinfelder KF, Taleghani AM. An alternative to cast etched retainers. Journal of Prosthetic Dentistry. 1987 Oct 1;58(4):424-8.
The retainers are
outlined in pencil
Prefabricated plastic
mesh patterns A pattern is trimmed on
the backing sheet and is
luted to the cast
The framework is waxed and cut back
The pattern is sprued,
ready for investing
The completed fixed
partial denture

22. Advantages:
1. Can be used with any alloy especially gold alloys and those with a high
palladium content, which have no etchants.
2. Elimination of the etching process. Therefore, reduced cost, time and health
hazards.
3. The grey discoloration commonly transmitted through the enamel when cast
etched retainers are used was not apparent with the mesh system.

23. 3. Maryland Bridge
• Maryland bridges are resin bonded bridge using
electrolytic etching of metal to retain the metal
framework using micromechanical retention.
• Thompson and Livaditis in 1983 developed a technique
of electrolytic etching of Ni-Cr and Co-Cr alloy.
1st step
3.5% nitric
acid
250 mA/sq.
cm
5 minutes
2nd step
18% HCl
10 mins
Ultrasonic
cleaning bath
Livaditis GJ, Thompson VP. Etched castings: an improved retentive mechanism for resin-bonded retainers. The Journal of prosthetic dentistry. 1982 Jan 1;47(1):52-8.

24. • Better retention: resin-etched metal
bond is stronger than resin to etched
tooth
• Retainers are highly polished and resists
plaque accumulation.
Advantages
• Etch is alloy specific requiring special
apparatus
• Only non-precious alloy which can be
etched is used. Precious alloys cannot
be etched.
Disadvantages

25. • Reverse Maryland Bridges
Utilizing the Maryland bridge applied from the labial and buccal aspect
Miller TE. Reverse Maryland bridges: clinical applications. Journal of Esthetic and Restorative Dentistry. 1989 Sep;1(5):155-63.

26. • THE PROCERA MARYLAND BRIDGE
• The Procera Maryland Bridge represents a further evolution of Livaditis’ initial concept.
• The one-piece zirconia framework incorporates an all-ceramic pontic connecting two wings that are bonded (or
cemented) to the lingual surface of the adjacent teeth.
• The framework is precision milled from a solid piece of zirconia after which porcelain was added and the
surface was acid-etched.
Holt LR, Drake B. The Procera Maryland bridge: a case report. Journal of Esthetic and Restorative Dentistry. 2008 Jun;20(3):165-71.

27. 4. Adhesive Bridges
• Chemically active adhesive cements were developed for direct
bonding to metal.
Metal etching
Chemical adhesion
Eakle WS, Lacy AM. A clinical technique for bonding gold castings to teeth. Quintessence International. 1991 Jun 1;22(6).
The preparation is treated with a
self-curing enamel and dentinal
bonding agent.
The internal surface of the
casting is sandblasted and
electroplated with tin to
produce a surface suitable for
bonding with a resin cement

28. Adhesive systems
Chairside
systems
Laboratory
systems
Metabond
1st adhesive resin system
MMA
polymer
MMA
monomer
Catalyst:
Tributyl
borate
Superbond
• Highest initial bond strengths
• Weak bond with gold alloys
• Bond shows hydrolytic instability.
Adhesion: 4-
META
Rosensteil SF et. al. Contemporary Fixed Prosthodontics( St Louis, Mosby, Third edition) pg 676-679
Silicoater
Classical
• Intermediate layer
containing silica as this
provides sufficient
bonding of the resin via a
silane bonding agent.
Rocatec
System
• A tribochemical silica
coating is sandblasted
onto the metal surface to
provide ultrafine
mechanical retention

29. 5. Fibre reinforced composite resin
Vallittu PK. Experiences of the use of glass fibres with multiphase acrylic resin systems. InThe first symposium on fiber reinforced plastics in dentistry. Biomaterials project 1998.
University of Turku.

30. Consists of a fiber
reinforced
substructure
Veneered with
composite
material
Flexural strength
Fracture resistance
Tensile strength
Transluscent
Vallittu PK, Sevelius C. Resin-bonded, glass fiber-reinforced composite fixed partial dentures: a clinical study. The Journal of prosthetic dentistry. 2000 Oct 1;84(4):413-8.

31. Types of
fibres
Glass
Polyethylene
Polypropelene
Carbon
Orientation
Unidirectional
Braided
Woven
Non-
impregnated
Pre-impregnated
and machine
formed
Pre-impregnated
and woven

32. Indications
Esthetics
The need to
decrease
wear of the
opposing
dentition
The use of
conservative
abutment
tooth
preparations
The desire
for a metal-
free,
nonporcelain
prosthesis
Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Prosthodontics-E-Book. Elsevier Health Sciences; 2015 Jul 28.

33. Contraindications
Inability to
maintain good
fluid control
Long span
(i.e., two or
more pontics)
Patients with
parafunctional
habits
Patients with
unglazed
porcelain or
removable
partial
denture
frameworks
that would
oppose the
restoration

34. COMPLETE COVERAGE
FIXED PROSTHESES
PARTIAL COVERAGE FIXED
PROSTHESES

35. Combination bridges
1. Compound bridge
A combination of any two or more of the conventional bridge designs is referred to as a compound
bridge

36. 2. Hybrid bridges
Resin
bonded
retainers
Conventional
retainers
Hybrid
bridge
Major
retainer
So that debonding does not require
replacement of conventional retainer.
• Fixed movable connectors are employed in case of hybrid bridges.
Allan DN, Foremen PC. Crown and Bridge Prosthodontics : an illustrated handbook (Briston, Wright1986)

37. Design variations for special situations
Andrew’s bridge
Removable bridge
Telescopic prosthesis
Non-rigid Connectors

38. 1. Andrews bridge
Fixed component Removable component

39. • One of the first attempts of fixed RPD was by Fossume in 1904
Round bar attached to abutment crowns that supported a
suprastructure
Rhoads JE. The fixed-removable partial denture. Journal of Prosthetic Dentistry. 1982 Aug 1;48(2):122-9.
Rotational stability was provided by flanges covering soft tissue.
Dolder
Hader
Baker

40. • In 1966 Andrew came up with Andrew’s bridge system.
Prefabricated parallel
rectangular bars
Matching sleeve
• These prefabricated units were made of precision machined stainless steel rather than gold alloy.
• Very high tensile and yield strengths were claimed for the material so that the bar could be made
thin and also occupy minimal vertical space

41. 2 bars
Anterior Single bar
Posterior Twin bar
• Three lengths
• Three different curvatures
Each curve Part of a circle
Easy
reconstruction in
case of damage
• This bridge design gives very good retention and stability with optimum esthetics.

42. Advantages:
1. Flexibility in placing
denture teeth
2. Effective oral hygiene
3. Increased stability of the
splinted teeth.
Disadvantages:
1. Crown lengthening and
soldering.
2. Complex laboratory
steps
Indications:
1. Patients whose residual ridge has
a relationship to the opposing
dentition that would prohibit the
esthetic placement of the pontics
of a fixed partial denture
2. Patients requiring diastemas to
harmonize the natural dentition.
3. Patients who have extensive
alveolar bone and tissue loss

43. 2. Removable Bridge
• It is a periodontal prosthesis, introduced by Dexter in 1883.
• It has a provision for modification and conversion in case of future loss of abutment teeth.
Used when preservation of abutments is desired with a stable, less retentive prosthesis than with
a more retentive, rigid prosthesis for a shorter period of time.
Long span edentulous
bridges:
Disadvantages in permanent
cementation

44. Cementing individual cast gold copings to each of the abutment
teeth, followed by temporary cementation of a superstructure
bridge on the copings.
Indications:
1. Periodontally weak teeth
2. Cariously involved teeth
3. Endodontically treated teeth
4. Non-parallel abutments
5. Long edentulous span.
Disadvantage:
1. Extensive lab work
2. Limited retention and stability
3. Extensive tooth preparation.

45. 3. Telescopic prosthesis
Langer Y, Langer A. Tooth-supported telescopic prostheses in compromised dentitions: A clinical report. Journal of Prosthetic Dentistry. 2000 Aug 1;84(2):129-32.

46. • Used in non-parallel abutments.
• The telescopic crown enables the mesial and distal
surfaces to be prepared for one line of insertion
(the inner sleeve) while the line of insertion of the
bridge is reproduced on the outer surface of the
sleeve.
Advantages
Easy access for oral
hygiene
Better retention
Can include teeth with
questionable long-term
prognosis

47. 4. Non-rigid connectors
Non-rigid connectors
The use of rigid connectors
between pontic and retainers is the
preferred method for fabrication of
most fixed partial dentures

48. Indications:
Pier
abutments
Malaligned
abutment
Mobile
teeth
Long span
FPDs
Badwaik PV, Pakhan AJ. Non-rigid connectors in fixed prosthodontics: Current concepts with a case report. J Indian Prosthodont Soc. 2005 Jun 1;5:99-102.

49. Loop
connectors
Cross pin
and wing
connectors
Split
pontic
connector
Tenon-
mortise
connectors

50. • Tennon-mortise connectors
Tennon (male component)
Mortise (female component)
Shillingburg, Herbert T. 1997. Fundamentals of fixed prosthodontics. Chicago: Quintessence Pub, 3rd ed., pgs 530-532

51. Keyway placed on distal
aspect of anterior retainer
diverging occlusally
Key placed on mesial
aspect of pontic diverging
occlusally
Rosenstiel, S. F., Land, M. F., & Fujimoto, J. (2006). Contemporary fixed prosthodontics. St. Louis, Mo: Mosby Elsevier.

52. Keyway is fabricated
in the wax pattern
Casting of 1st part
done
Autopolymerizing
acrylic resin inserted
into the keyway and
then attached to the
2nd part
2nd part casted
separately
Banerjee S, Khongshei A, Gupta T, Banerjee A. Non-rigid connector: The wand to allay the stresses on abutment. Contemp Clin Dent. 2011;2(4):351–354.

53. • Reverse key and keyway.
Alternative orientation
The key is attached to the
distal surface of the anterior
retainer and is inverted so that
its taper converges occlusally.
The keyway is also inverted and
incorporated in the mesial surface of
the pontic, with the opening
positioned on the tissue surface of the
pontic.
Moulding, M. B., Holland, G. A., & Sulik, W. D. (1992). An alternative orientation of nonrigid connectors in fixed partial dentures. The Journal of Prosthetic Dentistry, 68(2),
236–238.

54. Custom made dovetail connector
Custom made attachment
from sleeve of Dowel pin
The dovetail or cylindrically
shaped mortise is fabricated
parallel to the path of withdrawal
of a distal retainer
Second half or the patrix is
fabricated
Pandey P, Mantri SS, Deogade S, Gupta P, Galav A. Two part FPD: Breaking stress around pier abutment. IOSR J Dent Med Sci. 2015;14:68-71.

55. • Split pontic
• This is an attachment that is placed entirely within the pontic.
• It is particularly useful in tilted abutment cases
The underside of the arm is
shaped like the tissue-
contacting area of a pontic
Casting of mesial half is done
Wax is poured onto it
Casting of distal half
Shillingburg, Herbert T. 1997. Fundamentals of fixed prosthodontics. Chicago: Quintessence Pub, 3rd ed., pgs 530-532

56. In cases of tilted molar abutments, a split pontic is highly useful.
Ney Mini Rest assembly
The Mini Rest should be positioned
approximately in the center of the
edentulous space
Female portion
Male portion
Anterior retainer is waxed and distal arm
contains the female component of Mini
Rest.
Posterior half containing male
component is attached and casted
separately
O'Connor RP, Caughman WF, Bemis C. Use of the split pontic nonrigid connector with the tilted molar abutment. Journal of Prosthetic Dentistry. 1986 Aug 1;56(2):249-51.

57. • Cross pin and wing connector
i. The cross-pin and wing are the working elements of a two-piece pontic system that allows
the two segments to be rigidly fixed after the retainers have been cemented on their
respective abutment preparations
ii. The design is used primarily in teeth with disparate long axes. The path of insertion of each
tooth preparation is made parallel to the long axis of that tooth.
Vertical wing attached to the mesial surface
of the distal retainer wax pattern, following
the contour of the underside of the pontic.
Specifications of the wing:
1. Parallel to the path of insertion
of mesial abutment
2. Extend 3mm mesially
3. 1mm faciolingual thickness
4. 1mm short of occlusal surface

58. Cast distal retainer with
wing
Drill 0.7-mm hole
through the wing
Place pencil lead and
build the wax pattern
around the lead and the
wing.
Assemble the two parts
and smoothen the hole
in the pontic and wing
Fabricate a pin of the
same alloy and it should
be long enough to
extend through the
pontic-wing assembly
Try the pin for fit in the
components on the cast.
Cement the retainer with
the wing first, followed
by the retainer-pontic
segment
Seat the pin in the hole
with a punch and mallet
Remove excess length
from the pin both facially
and lingually

60. • Loop Connector
• Loop connectors are required when an existing diastema is to be maintained in a planned fixed
prosthesis.
• The connector consists of a loop on the lingual aspect of the prosthesis that connects adjacent
retainers and/or pontics
• The loop may be cast from sprue wax that is circular in cross section or shaped from a platinum-gold-
palladium (Pt-Au-Pd) alloy wire.
• Meticulous design is important so that plaque control will not be impeded

61. Loop connector + RBFPD
A more conservative approach for a loop connector is a loop connector + RBFPD
Dandekeri SS, Dandekeri S. Single anterior tooth replacement by a cast lingual loop connector - a conservative approach. J Clin Diagn Res. 2014;8(9):ZD07–ZD8.

62. Implant retained fixed prosthesis
It could be in the form of single tooth implants or implant acting as abutments in long span bridges.
Initial concept:
Bone driven
implant placement
Now: Restoration
driven implant
placement
Maximum
functional
and esthetic
benefits

63. According to Misch, the fixed prosthetic options can be divided as:
Misch CE. Dental Implant Prosthetics. 2nd ed. Amsterdam, Netherlands: Elsevier Health Sciences; 2014.

64. Significantly reduced bulk therefore,
more comfortable
No mucosal support is needed,
patients can chew with greater force
Gain of posterior mandibular bone
Enhanced social confidence
Advantages

65. Prosthetic Options in Fixed Full-Arch Restorations:
Porcelain-metal
Restoration
Ceramic layer bonded
to a cast metal
framework
Increased bulk of
metal used in the
substructure to keep
porcelain to its ideal
2mm thickness.
Hybrid
prosthesis
Metal framework +
acrylic resin + artificial
denture teeth
The impact force
during dynamic
occlusal loading also is
reduced
Egilmez F, Ergun G, Cekic-Nagas I, Bozkaya S. Implant-supported hybrid prosthesis: Conventional treatment method for borderline cases. Eur J Dent. 2015;9(3):442–448.

66. • Tooth-Implant supported fixed prosthesis
Anatomical limitations of space for implants or failure of an implant to osseointegrate may create a
situation in which it would be desirable to connect the implants to teeth.
• The tooth-implant supported prosthesis was first introduced
by Ericcson et al.
• The observed satisfactory outcome of the use of
osseointegrated titanium fixtures and teeth as abutments
in the same fixed-bridge reconstruction
Ericsson, I., Lekholm, U., Branemark, P.-I., Lindhe, J., Glantz, P.-O., & Nyman, S. (1986). A clinical evaluation of fixed-bridge restorations supported by the combination of teeth
and osseointegrated titanium implants. Journal of Clinical Periodontology, 13(4), 307–312.

67. Combined Implant and Tooth Support: An Up-
to-Date Comprehensive Overview
Reviewed 124 articles and concluded that:
1. There are 3 schools of thought: one school advocates nonrigid tooth and implant connection; another
prefers rigid connection, while the third recommends that implants and teeth should not be
connected.
2. Joining teeth and implants during the rehabilitation of partial edentulism provides more treatment
options where proprioception and bone volume are maintained and distal cantilevers and free end
saddles are eliminated.
3. To improve treatment success rate, it is better to avoid using short implants, poor bone quality, and
endodontically treated teeth when this treatment paradigm is considered. Also, using rigid connection
and permanent cementation are associated with less tooth intrusion and less complications.
Al-Omiri MK, Al-Masri M, Alhijawi MM, Lynch E. Combined Implant and Tooth Support: An Up-to-Date Comprehensive Overview. Int J Dent. 2017;2017:6024565.

68. Biomechanical Responses of Endodontically
Treated Tooth Implant–supported Prosthesis
• Objectives: This study was designed to investigate the biomechanical interactions in
endodontically treated tooth implant–supported prosthesis with variations in implant system and
load type by using the nonlinear finite element (FE) approach
• Results:
i. Splinting an endodontically treated tooth to an implant decreased stress values
in dentin and post but increased stress of implant and bone.
ii. The oblique occlusal forces increased the stress values relative to those of axial analogs.
iii. A splinted system with a 2-piece implant increased stress on the bone and decreased
stress on the prosthesis compared with that of the 1-piece implant.
Wang JC, Huang SF, Lin CL. Biomechanical Responses of Endodontically Treated Tooth Implant–supported Prosthesis. Journal of endodontics. 2010 Oct 1;36(10):1688-92.

69. Biomechanical comparison of implant retained fixed partial
dentures with fiber reinforced composite versus
conventional metal frameworks: A 3D FEA study
• A 3-dimensional FEA was constructed to investigate the effect of two different framework materials
(metal and FRC) and two different veneering materials (porcelain and particulate composite) under
the functional loading.
• Conclusion:
1. FRC + Composite = less stress values in the prosthesis but high stress values in implant-abutment
complex
2. Implant supported FRC-FPD eliminate the excessive stresses in the bone–implant interface, maintains
normal physiological loading of the surrounding bone and minimizes the risk of periimplant bone loss
due to stress shielding.
3. FRC-FPDs may be a good alternative as opposed to conventional metal FPDs for implant-supported
prosthesis in the future. Further clinical studies are needed to more intensively evaluate the potential of
these materials in implant prosthodontics.
Erkmen, E., Meriç, G., Kurt, A., Tunç, Y., & Eser, A. (2011). Biomechanical comparison of implant retained fixed partial dentures with fiber reinforced composite versus
conventional metal frameworks: A 3D FEA study. Journal of the Mechanical Behavior of Biomedical Materials, 4(1), 107–116.

70. CONCLUSION
A common axiom in conventional prosthodontics for partial edentulism is a fixed partial denture.
Fewer the natural teeth missing better the indication for fixed partial denture. Unfortunately every
case is different in relation to anatomical variations, patient’s desires and medical condition,
therefore subtle modifications in designing are required to suit a given particular case.
Over the period of time many types of bridges have come up ranging from the traditional to resin
retained to the implant retained bridges. With the treatment options available today the primary
goal of a prosthodontist should be “meticulous replacement with maximum preservation.”

71. REFERENCES
• Madhok S, Madhok S. Evolutionary changes in bridge designs. IOSR J Dent Med Sci. 2014;13(6):50-6.
• Smith ED, Howe LC. Planning and making crowns and bridges. CRC Press; 2013 Oct 5, pg 197-203
• Rochette AL. Attachment of a splint to enamel of lower anterior teeth. The Journal of prosthetic dentistry.
1973 Oct 1;30(4):418-23.
• Livaditis GJ. Cast metal resin-bonded retainers for posterior teeth. Journal of the American Dental
Association (1939). 1980 Dec;101(6):926-9.
• Hudgins JL, Moon PC, Knap FJ. Particle-roughened resin-bonded retainers. Journal of Prosthetic Dentistry.
1985 Apr 1;53(4):471-6.
• Taleghani M, Leinfelder KF, Taleghani AM. An alternative to cast etched retainers. Journal of Prosthetic
Dentistry. 1987 Oct 1;58(4):424-8.
• Livaditis GJ, Thompson VP. Etched castings: an improved retentive mechanism for resin-bonded retainers.
The Journal of prosthetic dentistry. 1982 Jan 1;47(1):52-8.
• Badwaik PV, Pakhan AJ. Non-rigid connectors in fixed prosthodontics: Current concepts with a case report. J
Indian Prosthodont Soc. 2005 Jun 1;5:99-102.
• Shillingburg, Herbert T. 1997. Fundamentals of fixed prosthodontics. Chicago: Quintessence Pub, 3rd ed., pgs
530-53
• Rosensteil SF et. al. Contemporary Fixed Prosthodontics( St Louis, Mosby, Third edition) pg 676-679

72. • Miller TE. Reverse Maryland bridges: clinical applications. Journal of Esthetic and Restorative Dentistry. 1989
Sep;1(5):155-63.
• Holt LR, Drake B. The Procera Maryland bridge: a case report. Journal of Esthetic and Restorative Dentistry.
2008 Jun;20(3):165-71.
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