6.my unconventional fpd

2
UNCONVENTIONAL
FIXED PARTIAL
DENTURES

Contents
 Introduction
 Classification
 Resin bonded fixed partial dentures
Definition
Advantages
Disadvantages
Indications
Contraindications
Types
3

 Procedures
1. Tooth preparation
2. Fabrication of the frame work
3. Bonding of the restoration
 Fiber Reinforced Composite Resin FPD
 F i x e d / d e t a c h a b l e ( h y b r i d )
 Summary
 References
4

6
Fixed-
fixed
Fixed-
movable
Cantilever
H.T Shillingburg, . Fundamentals of fixed Prosthodontics. 1st ed

Spring
cantiliver
7
hybrid
prosthesis

8
Resin retained
fixed partial
dentures

DEFINITION
According to the glossary of prosthodontic terms
Resin bonded prosthesis: A prosthesis that is
luted to tooth structures primarily enamel
which has been etched to provide mechanical
retention for the resin cement.
Goal:
Replacement of missing teeth and maximum
conservation of tooth structure.
9

Advantages
1. Minimal removal of tooth structure.
2.Non invasive to dentin
3. Minimal potential for pulpal trauma.
4. Tissue tolerant because of supragingival
margins without gingival irritation.
10
H.T Shillingburg, . Fundamentals of fixed Prosthodontics. 3rd ed

5. Esthetically more appealing since only lingual surface
of anterior teeth are covered
6. No anesthesia hence less trauma to patient.
7. Simplified impression procedures
8. Interim restorations usually not required.
11
H.T Shillingburg, . Fundamentals of fixed Prosthodontics. 3rd ed

9. Reduced chair side time
10. Reduced patient cost…
11. Re-bonding possible.
12Rosenstiel, Land, Fujimoto. Contemporary fixed prosthodontics. 3rd
ed. Mosby Harcourt brace and Co; 2001

Disadvantages
1. Reduced restoration longevity
2. Enamel modifications are required
3. Good alignment of teeth are needed
4. Very thin or translucent anterior teeth are
limiting factor because of esthetics.
5. Usually restricted to single tooth
replacement
13
Rosenstiel, Land, Fujimoto. Contemporary fixed prosthodontics. 3rd ed.

6. No space and alignment correction.
7. Difficult temporization.
8. Uncertain longevity.
9. Esthetics is compromised on posterior teeth
replacement.
14

INDICATIONS
1. Replacement of congenitally missing tooth or
teeth lost by traumatic injuries especially in
young patients.
2. Splinting of periodontally compromised teeth.
3. Stabilizing dentition after orthodontic
treatment or movement.
4. Short span and in case on open bite.
15

5. Retainers of FPD for abutment with sufficient
enamel to etch for retention.
6. Significant crown length.
7. Unrestored abutments.
8. Medically compromised and adolescent
patients.
16

CONTRAINDICATIONS
1. Patients sensitivity to base metal alloy.
2. Parafunctional habits.
3. Long span involving 3 or more abutments.
4. Restored or damaged abutments.
5.Compromised enamel.
17

6. Significant pontic discrepancy.
7. Deep vertical overlap.
8. When facial esthetics of abutment require
improvement eg: stained, malformed or
malposed teeth.
9. Insufficient occlusal clearance to provide 2-3
mm vertical retention. eg: abraded teeth.
10. Incisors with extremely thin facilingual
dimension
18

Types Of Resin Bonded Fixed
Partial Denture Designs
1) Rochette
2) Maryland
3) Virginia
4)Fungs
19

CAST PERFORATED RESIN-RETAINED
FPDS: (ROCHETTE BRIDGE)
Alain Rochette in 1973
introduced this type of
bridge.
Bonding through
mechanical retention.
The metal retainer had
flared perforation so that
the bonding material gets
locked mechanically.
20

To prevent weakening
of the framework-
Too large and too
closely placed
perforations should
be avoided.
The perforations
should be
approximately 1 mm
apart and have a
maximum diameter
of 1.5mm.
21

Replacement of
posterior teeth –
Livaditis
Extension –
interproximally and
onto occlusal
surfaces.
Survival rate -3
years
22

ADVANTAGES
1) It is easy to see the retentive perforations in
the metal.
2) If the bridge must be replaced, the composite
resin can be cut away in the perforations to
aid in the removal process.
3) No metal etching is required.
23

Disadvantages
1) The perforations would weaken the retainers
if improperly sized or spaced.
2) The exposed resin is subjected to wear.
3) It is not possible to place perforations in
proximal surface or in the rest.
24

ETCHED CAST RESIN RETAINED FPDS:
(MARYLAND BRIDGE)
Thompson and
Livaditis developed
this type of FPD at
University of
Maryland.
The retention is
micro mechanical
ie, through
electrolytic etching
of Ni-Cr and Cr-Co 25

Lividatis and Thompson used a
3.5% solution of nitric acid with a current of 250 mA/cm
for 5 min,
Followed by immersion in an 18% hydrochloric acid
solution in an ultrosonic cleaner for 10 min
This technique was specific to non beryllium nickel
chrome alloy.
26

Thompson et al reported that
10% sulphuric acid at 300 mA/cm2,
followed by same cleaning methods, would
produce similar results in beryllium
containing nickel chrome alloy.
27

Advantages
1. It is reported to have improved bond
strength.
2. Retention is improved because the resin-to-
etched metal bond can be substantially
stronger than the resin-to-etched enamel.
3. Instead of perforations, the tooth side of
the framework is electrolytically etched,
which produces microscopic undercuts.
28

4. It can be used for both anterior and posterior
bridges
5. The retainers can be thinner and still resist
flexing.
6. The oral surface of the cast retainers is highly
polished and resists plaque accumulation.
29

Disadvantages
Although this design has been reported to be
stronger, it is more technique sensitive
because the retainers may not be properly
etched or may be contaminated before
cementation.
Because the retentive features are not seen with
the unaided eye the etched surface must be
examined with a microscope to verify proper
etching.
30

3. MACROSCOPIC MECHANICAL RETENTION
RESIN RETAINED FPD: (VIRGINIA BRIDGE)
Moon and Hudgins et al produced particle roughened
retainers by incorporating salt crystals into the
retainer patterns to produce roughness on the inner
surfaces.
This method is also known as lost salt technique
31

LOST SALT TECHNIQUE
The framework is outlined on the die with a wax
pencil and the area to be bonded is coated first
with model spray and then with lubricant.
Sieved cubic salt crystal (NaCl), ranging in size
from 150 to 250 mų are sprinkled over the
outlined area.
32
The retainer patterns are fabricated from resin
leaving 0.5 to 1.0mm wide crystal free margin
from the outlined area.

Application of resin pattern
Pattern investment,salt crystals are dissolved
from the surface
33

Advantages
1. It is of lower cost compared to custom made
resin – bonded bridges.
2. No need of impression making and laboratory
work.
3. Can be given to patient in a single appointment.
4. Good esthetics no exposure of metal in
proximal areas.
5. Longevity comparable to resin bonded bridges
http://www.fung-international.com/pdf/DI.pdf

FABRICATION of RBFPD
38
In fabrication of resin retained fixed partial
dentures, all three phases are necessary
for predictable success:
1) Preparation of abutment
teeth.
2) Design of restoration
3) Bonding of restoration.
Whether anterior or posterior teeth are
prepared common principles dictate tooth
preparation design.Rosenstiel, Land, Fujimoto. Contemporary fixed prosthodontics. 3rd ed.

39
Anterior tooth preparation and
frame work design

The finish line on the proximal surface adjacent
to the edentulous space should be placed as far
facially as is practical. Abutments should have
parallel proximal surfaces.
40

An optional slot, O.5mm in depth, prepared with
a tapered carbide bur, may be placed slightly
lingual to the labial termination of the
proximal reduction.
41

42
Leave the margins about 1mm for the incisal or
occlusal edge and 1mm supragingival if possible.
Wherever possible to enhance resistance more
than half the circumference of the tooth should
be prepared.

Preparation of mandibular anterior teeth is
similar to that for the maxillary incisors.
Lingual enamel thickness is 11 to 50 percent
less than for maxillary teeth and
consequently tooth preparation must be more
conservative.
43

Posterior tooth preparation and
framework design
The basic framework consists of three major
components.
1. The occlusal rest (for resistance to gingival
displacement)
2. The retentive surface (for resistance to occlusal
displacement)
3. The proximal wrap (for resistance to torquing
forces).
44

A spoon shaped
occlusal rest seat is
placed in the
proximal marginal
ridge area of the
abutments adjacent
to the edentulous
space. An
additional rest seat
may be placed on
the opposite side of
the tooth. 45

To resist occlusal displacement, the restoration
is designed to maximize the bonding area
without unnecessarily compromising
periodontal health or esthetics.
46

Proximal and lingual walls are reduced to
lower their height of contour to
approximately Imm. The proximal wall are
prepared so that parallelism results without
undercuts. 47

The bonding area
can be increased
through extension
onto the occlusal
surface provided it
does not interfere
with the occlusion.
Generally a knife-
edge type of
margin is
recommended.
48

.
49

In general, the preparation differs between
maxillary and mandibular molar teeth on
the lingual surface only. The lingual wall of
mandibular tooth may be prepared in a
single plane and the palatal surface of
maxillary molars dictates a two plane
reduction due to taper of these centric cusps
in the occlusal two thirds and occlusal
function.
50

Resin to metal bonding
Metal resin bonding can be classified as either
51

Electrolytic etching:
In this procedure microscopic porosity is
created in the fitting surface of a nickel
chromium framework by electrolysis.
Procedure
Clean the fitting surface of metal restoration
with an air abrasion unit with aluminium
oxide.
Cover the polished surfaces with wax and attach
the prosthesis to an electrolytic etching unit
following the manufacturers instructions.
52
Michel Degrange: Minimally invasive restoration with bonding

A typical etching cycle will be 3 minutes in
10% H2SO4 with a current of 300 milliamp
per square centimeter of casting surface.
Clean the etched surface ultrasonically in 18%
HCI, then wash and air-dry it.
The etched surface must not be handled after
this stage.
53

Chemical etching
A gel consisting of nitric and hydrochloric acid
is applied to the internal surface of the metal
framework for approximately 25 minutes.
As electrolytic etching is extremely sensitive,
many authors believe that chemical etching
provides more reliable results due to
procedural simplicity.
54

Silicoater Classical
Tiller et al (1984)
Procedure – sand blasting of alloy
Flame coating of silica-carbon for 5
minutes,thus the surface bonds to composite
Disadvantage –
1. Expensive
2. Uneven distribution of flame
3. Chemically unstable silica layers
4. Protection of the layer formed
55

Rocatec System
Introduced in 1989
The metal surface is abraded with 120microns
alumina
Followed by abrasion with silicate particle-
containing alumina.
Silane application thus adhesive to composite
resin.
56

MACROSCOPIC
RETENTION
In non-perforated retainer, porosity is cast
in the pattern itself rather than
subsequently obtained by etching.
This is done in variety of ways:
1. Lost salt technique.
2. One techniques uses a special pattern to
form a meshwork on the fitting surface and
the external lingual surface is waxed to
give a smooth finish that can be highly
polished.
57

Advantages
1. any alloy can be selected, whereas with
electrolytic or chemical etching the alloy
usually must be nickel chromium.
2. try-in and bonding of the prosthesis can be
accomplished at the same appointment.
58

Disadvantages
1. Difficulty on adapting the mesh to create a
closely fitting metal framework
2. A potentially thicker metal framework than
can be obtained with a etched metal retainer
3. The rate of microleakage along the cast mesh
composite resin interface is significantly
greater than along an etched metal resin
interface 59

Tin plating is a recently introduced procedure
that can improve the strength of adhesive
cement to most metals.
Precious alloys can be plated with tin and used
as frameworks for resin retained fixed partial
dentures.
Tin forms organic complexes with several
specific adhesive resin cements that result in 60
TIN PLATING (CHEMICAL BONDING)

BONDING AGENTS
Composite resins play an important role in the
bonding of the metal framework to etch
enamel. They conatin
I) Filled BisGMA composite resin (Bisphenol A
glycidil methacrylate).
2) TEGDMA (Triethylene glycel
dimethacrylate).
3) 4META (4 methacrylyloxethyl trimellifate
61

Cements with adhesion
promoters
PANAVIA
Components: low viscosity paste, radio opaque
composite resin paste
Universal and catalyst
Composition : Bisphenol-A-Polyethoxy
dimetharyclate,
MDP or 10-Methacrloxydecyl dihydrogen
phosphate, 77%silanated organic fillers.

Mixing time : 20-30 sces
Film thickness: 19 microns
Metal surface must be sandblasted or tin
coated.
Recent version – PANAVIA F

C&B METABOND
COMPOSITION:
Methylmethacrylate
polymer powder
Mma liquid modified
with 4-META or
4 Methacryloxyethyl
Trimellitic
Anhydride.
Tri-n-Butyl Borane
catalyst.
Disadvantage-poor
hydrolytic stability

66

67

Post operative care
Regular recall visits
Check for any debonding
Caries
Periodontal health

Fiber Reinforced Composite Resin
FPD
1. Consists of a fibre reinforced substructure
2. Veneered with composite material
3. Increased flexural strength , fracture
resistance & increased tensile strength
4. Transluscent

Types Of Fibres
1. Glass
2. Polyethylene
3. Polypropylene
4. Carbon

Orientation of the fibre
1. Unidirectional
2. Braided
3. Woven

Procedure
1. Preparation of abutment
teeth
2. Measurement of fiber
length
3. Moistening of fiber
4. Fiber bar pressed into the
preparation & polymerised
with resin
5. Pontic build up & curing

FIXED REMOVABLE FPD
Fixed-movable Bridge–
These are similar to fixed-fixed bridges but
have a movable joint (not detectable by the
patient) allowing the use of a bridge when
retaining teeth that are not favourably
aligned.
Eg:- Andrews bridsge
75

FIXED REMOVABLE FPD
Andrews bridges:-
Fixed removable partial dentures are particularly
indicated for patients with extensive supportive tissue
loss and when the alignment of the opposing arches
and/or esthetic arch position of the replacement teeth
create difficulties
76
J Prosthet Dent. 1983 Aug;50(2):180-4

77
A FIXED REMOVABLE PARTIAL DENTURE
TREATMENT FOR SEVERE RIDGE DEFECT
Int J Dent Case Reports 2011; 1(2): 112-118

SPRING CANTILEVER
BRIDGE
78
.
DEFINITION :

  It is a bridge that carry the
pontic by a tooth not
  immediately related to it
and connect to it by a
  flexible palatal bar.
  .
  .
The bar must sufficiently
flexibile to allow it to be
pressed on to and gain
support
from the mucoperiosteum
during mastication

79
1.Where aesthetics is of prime importance .
2.Where the teeth on either side of the space
are unsuitable as abutments because there is
insufficient retention or the teeth are
periodontal disturbed and unable to carry
additional load .
3.Where a Diastema is need to be preserved on
one or both sides of the pontic .
INDICATIONS :

80
1.In young patients where the clinical crowns are
short and
of inadequate retention .
2.When the teeth on either side of the space need
crowning in
replacement of lower tooth .
3.When the shape of the palate is unfavorable .
4.Where there is sever soft tissue loss .
5. When the proposed abutment tooth is
unopposed or
CONTRAINDICATIONS :

81
Pier abutments Tilted molars

References
Textbook references:
1. Rosenstiel, Land, Fujimoto. Contemporary fixed
prosthodontics. 3rd ed. Mosby Harcourt brace and Co;
2001
2. H.T Shillingburg, Sumiya Hobo, Lowell D. Whitsett.
Fundamentals of fixed Prosthodontics. 3rd ed.
Quintessence Publishing CO, Inc; 1997
3. W.F.P. Malone, D.L Koth, E. Cavazos, Jr. Tylman's
theory and practice of fixed th prosthodontics. 8 ed.
Ishiaku Euro America .p.219-228.
4.Direct bonded retainers.Gerald McLaughlin
5.Minimally invasive restorations with bonding: Michel
Derange/Jean-Francois Roulet
6.Resin Bonded Bridges:technique for success;
K.A.Durey,P.J.Nixon BDJ2011;211:113-118
7.Quintessence International;Jul/Aug2009, Vol. 40 Issue
7, pe3
83

6.my unconventional fpd

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