- A fixed partial denture (FPD) replaces missing teeth and is cemented permanently to adjacent natural teeth or implants. - Key components of an FPD include retainers attached to abutment teeth, a pontic that replaces the missing tooth, and a connector that joins the pontic and retainer. - Proper evaluation of potential abutment teeth considers factors like crown-root ratio, root configuration, bone support, and overall oral health to ensure the FPD can withstand functional forces.

2. Diagnosis and treatment plannig
in FPD
Dr.Prasad Aravind MDS
Department of Prosthodontics

3. Objectives
• Functions of a crown and how the fpd replaces
the lost teeth and tissues
• To arrive at a diagnosis based on the
examination of the soft tissues and hard tissues
of the mouth
• What type of designs various situations
demands

4. Contents and Body
• What is a fixed partial denture?
• Criteria for giving an fpd
• Definition
• Parts
• Types
• Uses
• Indications,contraindications of an fpd

5. Fixed partial dentures-Introduction

6. Definition
A restoration or replacement
which is attached by a cementing
medium to natural teeth,roots or
implants.

7. Abutment
Any tooth,root or implant
which gives attachment and
support to the fixed partial
denture

8. Components of fpd

9. Crown
It is a cemented extracoronal
restoration that covers or
veneers the outer surface of the
clinical crown

10. Retainer
Retainer is a part of the
fixed partial denture which
unites the abutments to the
remainder of the restoration

11. Pontic
The artificial tooth that
replaces a missing tooth in
a fixed partial denture

12. Connector
Connection that exists
between the pontic and the
retainer

13. Metal ceramic crown

16. Functions of a crown
• Primary function of a crown is to protect the
underlying tooth structure and restore function
form and esthetics
• A full veneer crown covers all five surfaces of
the clinical crown
• If the prosthetic crown does not cover the
entire clinical crown it is refered to as a partial
veneer crown

17. Indications of fpd
• Short span edentulous arches
• Presence of sound teeth that can offer
sufficient support adjacent to the edentulous
space
• RRR where rpd will not be stable or retentive
• Mentally compromised and physically
handicapped patients who cannot maintain an
rpd.

18. Contraindications
• Cases where there is large amount of bone loss
as in a trauma
• Young patients with large pulp chambers
• Periodontally compromised abutment
• Long span edentulous spaces
• Bilateral edentulous spaces that require cross
arch stabilization

19. • Congenitally malformed teeth which do not
have adequate tooth structure[amelogenesis
imperfecta,dentinogenesis imperfecta]
• Medically compromised patients like
hypertension,bleeding disorders,leukemia etc,
• Mentally sensitive patients,very old patients.

21. Advantages
• Less bulky so increased patient comfort
• More natural feel
• Biting efficiency and chewing force generated
is more
• Need not remove the prosthesis at night

22. Disadvantages
• Tooth preparation may damage pulp
• May require Rct if tooth becomes nonvital
• Teeth preparation involves a lot of chair side time
• Difficult to do procedure on medically compromised
patients
• Expensive procedure
• If ceramic fractures difficult to retrieve the prosthesis

23. • If ceramic fractures its difficult to repair it
without cutting open the fpd from the mouth
• So Expense doubles for repair

27. Diagnosis and treatment planning

28. Diagnosis and treatment
planning
• Fpd success depends on the health of the
abutment
• Factors like dental caries,periodontal disease
etc can affect the health of the abutment and in
turn effect the outcome of the treatment.

29. Important for arriving at a diagnosis
• Extra oral Examination
• History taking
• Clinical Examination
• radiological examination
• study of the mounted diagnostic casts are
absolutely essential

30. Summary
• Advantages
• Disadvantages
• Diagnosis

31. Mouth opening

32. Palpating the
muscle to check for
its tonicity

34. History
• Diabetes:chances of periodontal problems are
high and also increases the risk of abutment
failure
• Xerostomia:leads to caries[vitaminA
deficiency,salivary gland
disease,anticholinergic drugs,antihypertensives
• Chose alternate option

35. • Cardiovascular:patients with pacemakers avoid
all electrosurgical procedures
• Adrenaline to be avoided in local anesthesia
• Gingival retraction cord to be free of
adrenaline
• Enquire about drug allergy,nickel sensitivity

36. Clinical examination
• Systemic examination: A thorough check up
should be made to rule out the presence of any
systemic disease
• Local examination:extraoral and intraoral
• Extraoral check for the muscles of mastication
and tmj
• Intraoral check the hard tissue and soft tissue
• Oral hygiene,attached gingiva,dental
caries,periodontal disease,faulty occlusion etc

37. Diagnostic casts
• Mounted using semiadjustable articulator
using a face bow transfer
• Helps to assess the dimensions of edentulous
space
• Height,rotations,inclinations of the abutment
teeth,supraeruption etc
• Wear facets
• Type of occlusion can be understood

40. Summary
• Checking the muscles for tonicity
• History
• Clinical examination
• Diagnostic casts

42. Radiographic examination
• Full mouth xray , opg
• Carious teeth
• Caries beneath restoration
• Level of bone
• Crown root morphology
• Crown root ratio of abutment
• Quality of endo treatment

43. Supraeruption

44. Widening of periodontal space in trauma from
occlusion

45. • Width of periodontal ligament space[increased
in trauma from occlusion]
• Root stumps
• Impacted tooth
• Any other pathology like cysts
• Thickness of soft tissues

47. References
• 1.shillinberg
• 2.Deepak Nallasamy

48. Treatment planning in fpd

49. Treatment planning in Fpd part 1
• Evaluation of abutments
• Biomechanical considerations

50. Evaluation of abutments

51. Abutment evaluation
• Abutment should withstand constant occlusal
forces
• Forces are transmitted via the retainer,pontic
and connector to the abutment teeth
• Ideal abutments should be vital
• If endo treated check if treatment is complete
and tooth has adequate bulk
• Post and core better if coronal tooth structure
is less

52. Factors in the selection of an abutment
• Crown root ratio
• Root configuration
• Periodontal ligament area

53. Crown-root ratio
• Optimum crown-root ratio is 2:3
• Minimum acceptable ratio is 1:1
• More lateral forces if ratio is greater than1:1
• If the opposing occlusion is not natural teeth
then less than1:1ratio may also be enough as
forces will be less
• Natural teeth 150lbs,Rpd- 26lbs,Fpd-54.5 lbs

54. Crown root ratio

55. Root configuration
• Roots that are broader labiolingually than mesio
distally eg premolar better than centrals.
• Multirooted posterior teeth with widely separated
roots will offer better periodontal support than roots
that are fused
• Teeth with Conical roots can be used for short span
fpd
• Single rooted tooth with irregular configuration or
with curvature in the apical third is better than a root
with a perfect taper

56. Root configuration

57. Root configuration

58. Periodontal ligament area
• Antes law
• Any fpd with more than two teeth are high risk
• Possible to do fpd repacing more than two
teeth
• Teeth with low perio support can serve as
support in selected cases[splinting]
• Avoid herodontics
• Advice good post op recall and checkup

64. Biomechanical considerations

65. Cantilever

71. Biomechanical considerations
• Longer pontic spans have a potential for more
torquing forces on the fpd,esspecially on the
weaker abutment
• A secondary abutment must have at least as much
as root surface area and a favourable crown-root
ratio as the primary abutment[canine ok as a
secondary abutment for a first premolar but its
unwise to use a lateral incisor as a secondary
abutment for a canine

72. The retainers on secondary abutments will be placed in tension when the
pontics flex with the primary abutments acting as fulcrums

73. • The retainers on the secondary abutments must be at least as
retentive as the retainers on the primary abutments
• When pontic flexes,the tensile forces will be applied to the
retainers on the secondary abutments
• Also there should be sufficient crown length and space between
adjacent abutments to prevent impingement on the gingiva
under the connector

74. Arch curvature
• If pontics lie outside the interabutment axis
line,it act as a lever arm producing torquing
movement
• The first premolars are used sometimes as
secondary abutments for a maxillary four
pontic canine to canine fpd
• As tensile forces will be applied to the
premolar retainers they must have exellent
retention

76. walls of the facial and lingual grooves
counteract mesiodistal torque resulting
from the force applied to the pontic

78. Pier abutment
• A lone standing abutment with edentulous space on
both sides is called as a pier abutment
• Teeth in different segments of the arch move in
different directions
• Physiologic tooth movement,arch position of the
abutment and a disparity in the retentive capacity of
the retainers makes a 5 unit fpd a difficult choice

79. Pier abutment

80. Pier abutment

82. • Due to the curvature of the arch,the
faciolingual movement of an anterior tooth
occurs at a considerable angle to the
faciolingual movement of a molar
• These movements in diverse directions can
create stresses in a long span prosthesis that
will be transferred to the abutments

83. • As the prosthesis can flex stress can be
concentrated around the abutment teeth as
well as between the retainers and the
abutments
• The middle abutment can act as a fulcrum
causing failure of the weaker retainer.small
retainers will have weak retention.
• The loosened retainer will cause caries

84. • So there should be some means to neutralize
the effects of those forces
• A non rigid connector can be used for that
purpose
• Most common type of nonrigid connector is a
T-shaped key that is attached to the pontic
and a dovetail keyway placed within the
retainer

85. Non rigid connector

86. • The stress breaking device in a five unit pier abutment
fpd is located on the middle abutment
• If it is placed on the terminal abutment it could result in
the pontic acting as a lever arm
• Keyway is placed within the distal contours of the pier
abutment
• Key is placed on the mesial side of the distal pontic

87. • The long axis of the posterior teeth usually lean slightly
in a mesial direction and vertically applied forces
produces futher movement in this direction
• 98 % of posterior teeth tilt mesially when subjected to
occlusal forces
• If keyway placed on the distal side of the pier abutment
mesial movement seats the key into the keyway

88. Non rigid connector

91. • If the keyway is placed on the mesial side
causes the key to be unseated during its
mesial movement
• This can cause a pathologic mobility in the
canine or the failure of the canine retainer

92. Tilted molar abutment

93. Tilted molar abutment
• Usually seen with mandibular second molar
abutments
• It tilts mesially into the space occupied by the
first molars
• It becomes impossible to prepare the
abutment for an fpd along the long axes of the
respective teeth and achieve a common path
of insertion

95. • Its further complicated if the third molar is
present
• It will drift and tilt with the second molar
• The mesial surface of the tipped third molar
will encroach upon the path of insertion of the
fpd thereby preventing it from seating
completely

96. Orthodontic correction

97. • Uprighting of the molar by orthodontic
treatment is the treatment of choice
• Fixed appliance can be used to achieve this
• Three months is the average time required for
uprighting
• The third molar if present is often removed to
facilitate the distal movement of the second
molar

98. • In case the encroachment is slight the
problem can be remedied by recontouring or
restoring the mesial surface of the third molar
• Additional groves to be given for the
overtapered second molar to enhance
retention
• If tilting is severe more corrective measures
are used

99. • The second molar will arc occlusally as it
moves distally so it must be watched closely
and ground out of occlusion to allow it to
continue moving
• Immediately after removing the appliance the
teeth are prepared and a temporary fpd is
prepared to prevent post treatment relapse

100. Proximal half crown

101. • If orthodontic treatment is not possible a
proximal half crown can be used as a retainer
on the distal abutment
• This can be used only if the distal surface is
untouched by caries or decalcification
• Also the patient should be able to maintain
good oral hygiene

102. Non rigid retainer

103. Telescopic crown
• A telescopic crown and coping can also be
used as a retainer on the distal abutment
• A full crown preparation is made along the
long axis of the tilted molar
• An inner coping is made to fit the tooth
preparation,and the proximal half crown will
serve as the retainer for the fpd fitted over the
coping

105. Conventional type of fpd

106. Implant supported fpd

107. Implant supported fpd
• Less number of available abutments
• Long edentulous span
• Absence of distal abutments but good bone
• Broad flat ridge configurations
• Single tooth replacement
• High caries risk patients
• Young adults

109. Cantilever prosthesis

114. Always anterior cantelever

115. Avoid posterior cantilever

116. Pontic size should be small in case of
posterior cantelever

117. Resin bonded fpd
• Defect free abutments
• Single missing anterior tooth or premolar
• Single missing molar with minimal opposing occlusal load
• Sound abutments on either side of edentulous space
• Young patients
• Abutments with less than 15* angulation
• Absence of deep vertical overlap

119. Canine replacement fpd

121. Take up one idea.Make that one idea
your life-think of it,dream of it,live
on that idea.Let the
brain,muscles,nerves,every part of
your body,be full of that idea,and
just leave every other idea
alone.This is the way to success.

122. We are what our
thoughts have made
us;so take care about
what you think.Words
are secondary.Thoughts
live;they travel far.

123. The whole secret of
existence is to have no
fear.Never fear what will
become of you,depend on
no one.Only the moment
you reject all help are you
freed.

124. Never think there is
anything impossible for the
soul.It is the greatest
heresy to think so.If there
is sin,this is the only sin;to
say that you are weak,or
others are weak.

125. Condemn none:if you can
stretch out a helping
hand,do so.If you
cannot,fold your
hands,bless your
brothers,and let them go
their own way.

126. Be like the lotus,spreading
its fragrance;unaffected by
the slush in which it is born
nor by the water that
sustains it.

127. That man has reached
immortality who is
disturbed by nothing
material.

128. If faith in ourselves had
been more extensively
taught and practiced,iam
sure a very large portion of
the evils and miseries that
we have would have
vanished.

129. Holding on to anger is like
grasping a hot coal with the
intent of throwing it at
someone else;you are the one
who gets burned.

130. Budha
It is better to conquer
yourself than to win a
thousand battle.Then the
victory is yours.It cannot be
taken from you,not by angels
or by demons,heaven or hell.

131. Pontics

132. Components of fpd

133. • Design of pontic should be matching with
• Esthetics
• Function
• Ease of cleaning
• Maintenance of healthy tissue on the ridge
• Patient comfort

134. Material
• All metal
• Metal ceramic
• Metal free ceramic
• Metal with resin
• Ideally glazed ceramic is best suited because
of its polished nature goes well with gingiva

135. Materials

136. Tip of pontic to rest on keratinized gingiva

137. • Portion of pontic touching the ridge should be
as convex as possible
• Tip of pontic should not extend past the
mucogingival junction[ulcer]
• There should not be a space between the
pontic and the ridge on the facial surface of
the ridge

138. Types of pontics
• Conical
• Ovate
• Saddle or ridge lap
• Sanitary or hygienic
• Modified sanitary

139. Conical pontic

140. Conical pontic
• Rounded and cleanable
• Similar to the sanitary dummy by Tinker 1918
• Tip is small in relation to the overall size of the pontic
• Ideal for use in a thin mandibular ridge
• When used in broad flat ridges the large triangular embrasures will collect
debris
• Use limited to thin ridges in nonappearance zone

141. Ovate pontic

142. Ovate pontic
• Used when esthetics is of prime concern
• The tissue contact segment of the pontic is bluntly rounded and it is set
into the concavity
• Good in broad flat ridge giving appearance that it is growing from the
ridge
• Easily flossable
• Concavity can b created surgically or at the time of giving provisional
restoration

144. Saddle pontic

145. Saddle pontic
• This type of pontic Looks most like a tooth
replacing all the contours of the missing tooth
• Forms a large concave contact with the ridge
• Obliterates the facial,lingual and proximal
embrasures
• Also called as ridge lap

146. • Saddle pontic is difficult to clean
• The floss cannot traverse the tisue facing area
of the pontic
• Saddle pontic is difficult to maintain because
of its design and will cause inflammation,so it
should not be used

147. Modified ridge lap

148. • It gives the illusion of a tooth
• This design with a ceramic veneer is the most
commonly used pontic design in the
appearance zone for both maxillary and
mandibular fpd
• Ridge contact must extend no farther lingually
than the midline of the ridge
• Contour of the tissue contacting area should be
convex

149. • The nearly all convex surface of the pontic
helps to prevent food impaction and plaque
accumilation
• Tissue contact should be narrow mesiodistally
and faciolingually for better tissue response

150. Hygienic pontic or sanitary pontic

151. Sanitary or hygienic pontic

152. • Pontic has no contact with the ridge
• Used in nonappearance zone[mandibular 1st
molars]
• It restores occlusal function and stabilizes
adjacent and opposing teeth
• If esthetics is not required it can be made of
metal

153. • Occlusogingival thickness of the pontic should
be no less than 3mm
• Adequate space under the pontic to help easy
cleaning
• All convex design both faciolingually and
mesiodistally[conventional fish belly
appearance]

154. • Another design has the pontic like a concave
archway mesiodistally
• Undersurface is convex faciolingually
• Hyperbolic paraboloid
• Added bulk for connectors making it strong
• Access for cleaning is good

155. • Stress is reduced in the connectors
• An esthetic version of this pontic can be
created by veneering with porcelain those
parts of the pontic that are likely to be
visible,the occlusal half and the occlusal
surface of the facial surface
• This design is called arc-fixed partial denture
• Modified sanitary pontic or perel pontic

156. Flossing

157. Rounded angles better for easy cleaning

158. Interproximal brush

161. Swami vivekananda
All the powers in the
universe are already ours.It
is we who have put our
hands before our eyes and
cry that it is dark.

162. References
1. Contemporary fixed prosthodontics – 3rd edition
Stephen F. Rosensteil, Martin F. Land.
1. Fundaments of fixed prosthodontics – 3rd edition
Herbert T. Shillingburg, Sumiyo Hobo.
1. Tylman’s theory & practice of fixed prosthodontics
- 8th edition, 1989 – William F.P. Malone, David L. Koth.
1. Planning & making crowns & bridges
- Bernard G.N. Smith – 3rd edition 1998.
1. Fixed prosthodontics – Keith E. Thayer.