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Unconventional fixed partial dentures

This document discusses various types of unconventional fixed partial dentures. It begins by describing fixed partial dentures and their classification based on support provided. The main types discussed are: - Fixed-fixed bridges which provide rigid support on both ends of the pontic and require more tooth reduction but provide maximum retention and strength. - Cantilever bridges which provide rigid support at one end only and are more conservative but the pontic requires rigid construction to avoid distortion. - Spring cantilever bridges which use a long metal arm for support of a single pontic. Other types discussed include resin-retained bridges using minimal preparation, Maryland bridges using electrolytic etching for micromechanical retention, and fiber

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UNCONVENTIONAL FIXED PARTIAL DENTURES Eesha Mody II MDS SRM DENTAL COLLEGE, CHENNAI
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.
• 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
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.
• 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
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
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
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
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.
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
• 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
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.
• Indications Replacement of anterior teeth in children and adolescents Short edentulous span Unrestored abutments Single posterior tooth replacement Significant C:R length
• Contraindications Parafunctional habits Long edentulous span Restored or damaged abutments Compromised enamel Deep vertical overlap Nickel allergy Pontic width discrepancy
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
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
• 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.
Disadvantages: 1. Weakening of the metal retainer by perforations 2. Limited adhesion 3. Wear of composite resin 4. Thick lingual retainers 5. Plaque accumulation
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.
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
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
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.
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.
• 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
• 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.
• 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.
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
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
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.
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.
Types of fibres Glass Polyethylene Polypropelene Carbon Orientation Unidirectional Braided Woven Non- impregnated Pre-impregnated and machine formed Pre-impregnated and woven
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.
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
COMPLETE COVERAGE FIXED PROSTHESES PARTIAL COVERAGE FIXED PROSTHESES
Combination bridges 1. Compound bridge A combination of any two or more of the conventional bridge designs is referred to as a compound bridge
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)
Design variations for special situations Andrew’s bridge Removable bridge Telescopic prosthesis Non-rigid Connectors
1. Andrews bridge Fixed component Removable component
• 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
• 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
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.
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
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
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.
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.
• 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
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
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.
Loop connectors Cross pin and wing connectors Split pontic connector Tenon- mortise connectors
• 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
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.
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.
• 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.
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.
• 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
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.
• 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
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
• 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
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.
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
According to Misch, the fixed prosthetic options can be divided as: Misch CE. Dental Implant Prosthetics. 2nd ed. Amsterdam, Netherlands: Elsevier Health Sciences; 2014.
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
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.
• 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.
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.
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.
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.
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.”
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
• 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. • Eakle WS, Lacy AM. A clinical technique for bonding gold castings to teeth. Quintessence International. 1991 Jun 1;22(6). • 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. • 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. • Allan DN, Foremen PC. Crown and Bridge Prosthodontics : an illustrated handbook (Briston, Wright1986) • Rhoads JE. The fixed-removable partial denture. Journal of Prosthetic Dentistry. 1982 Aug 1;48(2):122-9. • 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. • 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. • 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. • Misch CE. Dental Implant Prosthetics. 2nd ed. Amsterdam, Netherlands: Elsevier Health Sciences; 2014.
• 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. • 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. • 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. • 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. • 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. • 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. • 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. • 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.
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Unconventional fixed partial dentures

  • 1.
    UNCONVENTIONAL FIXED PARTIAL DENTURES EeshaMody II MDS SRM DENTAL COLLEGE, CHENNAI
  • 2.
    INTRODUCTION • The dentalarch 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 dentalprosthesis: 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 VARIOUSBRIDGE 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 onthe 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 connectoron 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 retentionand 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 rigidsupport 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 conservativedesign. 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 isa 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 areminimal 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 asmuch 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 anteriorteeth in children and adolescents Short edentulous span Unrestored abutments Single posterior tooth replacement Significant C:R length
  • 14.
  • 15.
    1. Rochette bridge RochetteAL. 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. Castmetal 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 displacementof 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 ofthe 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 speciallysized 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 involvesthe 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 beused 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 MarylandBridges 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 PROCERAMARYLAND 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 adhesiveresin 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 reinforcedcomposite 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 afiber 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.
  • 32.
    Indications Esthetics The need to decrease wearof 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 fluidcontrol 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.
  • 35.
    Combination bridges 1. Compoundbridge 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 Sothat 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 forspecial situations Andrew’s bridge Removable bridge Telescopic prosthesis Non-rigid Connectors
  • 38.
    1. Andrews bridge Fixedcomponent Removable component
  • 39.
    • One ofthe 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 1966Andrew 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 Singlebar 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 inplacing 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 castgold 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 LangerY, 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 innon-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-rigidconnectors 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.
  • 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 ondistal 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 inthe 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 keyand 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 dovetailconnector 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 oftilted 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 pinand 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 retainerwith 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 fixedprosthesis 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 bulktherefore, 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 inFixed 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 supportedfixed 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 andTooth 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 ofEndodontically 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 ofimplant 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 axiomin 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. • Eakle WS, Lacy AM. A clinical technique for bonding gold castings to teeth. Quintessence International. 1991 Jun 1;22(6). • 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. • 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. • Allan DN, Foremen PC. Crown and Bridge Prosthodontics : an illustrated handbook (Briston, Wright1986) • Rhoads JE. The fixed-removable partial denture. Journal of Prosthetic Dentistry. 1982 Aug 1;48(2):122-9. • 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. • 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. • 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. • Misch CE. Dental Implant Prosthetics. 2nd ed. Amsterdam, Netherlands: Elsevier Health Sciences; 2014.
  • 73.
    • 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. • 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. • 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. • 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. • 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. • 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. • 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. • 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.
  • 74.

Editor's Notes

  • #5 A working classification of the bridge designs till date is as follows. There are four basic conventional bridge designs. Other non-conventional designs are the result of a challenging clinical situation.
  • #11 A pontic is supported at some distance from the retainer. It is a type of cantilever
  • #12 This is achieved by etching the enamel The basic diff btwn a reisn bonded retainer and a conventional fpd is mechanism of attachment of the retainer to the abutment tooth; the factors to be considered include the properties of the bonding resin, the retentive design of the framework, and the bonding technique The second characteristic is the ability to develop a fixed prosthesis that requires little or no removal of tooth structure.
  • #13 Weakest link in resin retained prosthesis is the bond between the framework and resin. Therefore to improve the retention various means have been developed – mechanical retention, micromechanical retention, macroscopic mechanical and chemical retention
  • #17 Rochette proposed the design on for anterior teeth. The posterior retainer can be divided into three segments: the occlusal rest, the proximal segment, and the lingual segment
  • #20 Developed by Hudgins in1984
  • #21 On the working cast a lubricant is then applied, within the outline of the retainer specially sized salt crystals (150 – 250 µm) are sprinkled leaving 0.5mm border without crystals at the periphery of the pattern. This is followed by application of a resin pattern. After pattern investment, the salt crystals are dissolved from the surface of the pattern. It uses macroscopic mechanical means of retention with the resin cement
  • #22 The pattern is placed on the surface of the cast where the pattern is to be made. Wax is added to this surface and cast in a conventional manner. The routine and periodic location of small undercuts on the surface provide an excellent means for mechanically holding the luting agent.
  • #24 Immersed in 18% HCl and placed in an ultrasonic unit for 10 minutes to remove the metal membrane that formed during etching.
  • #25 Retention is improved as resin to etched metal bond is substantially stronger than resin to etched enamel.
  • #28 Since alloy etching has various disadvantages These cements rely on chemical adhesion to the metal hence etching was no longer necessary In this technique 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
  • #29 adhesion promoter 4- META (4methacryloxyethyl trimellitate anhydride)
  • #37 Resin bonded retainers when used in combination with conventional retainers form hybrid bridges Resin bonded retainer acts as the major retainer so that debonding does not require replacement of conventional retainer.
  • #39 It is a fixed RPD having a fixed and a removable component. The fixed part has a bar connected to two retainers on either side of the edentulous space and harbors a removable acrylic partial denture
  • #40 Other variations that employed the “bar and clip” concept for retention and relied on extended tissue coverage for rotational stability were presented by Dolder’ and more recently by Baker, Hader, and Andrews
  • #42 matching sleeve to which replaced teeth and other supra-structure elements were attached.
  • #43 Two types of bars were manufactured: a single bar to use anteriorly and a twin bar for posterior gaps. These bars were available in three lengths of three different curvatures. Each curve was a segment of a and it simplified reconstruction should a patient lose or damage removable sections
  • #45 These differ from the traditional bridges. With large bridges there are disadvantages in permanent cementation in that the maintenance and further endodontic or periodontal treatment of abutment teeth is difficult and if something goes wrong with one part of the bridge or abutment usually the whole bridge has to be sacrificed.
  • #47 The term (telescopic denture) refers to the type of prosthesis that includes double crowns as retainers or attachments. These retainers (or attachments) consist of 2 crowns; primary or inner crown which is cemented to the abutment, and secondary or outer crown which is attached to the denture
  • #48 They allow for easy access for oral hygiene around the abutment teeth. The comparatively high retention obtained leads to good mastication and phonetics. Telescopic crowns also allow for an overdenture design that includes teeth with questionable long-term prognosis.
  • #49 But in certain cases such as 5unit pier abutments, long apan edentulous cases, malaligned teeth, non-rigid connectors should be used The connector that permits limited movement between the otherwise, independent members of the FPDs.
  • #50 which promote a fulcrum-like-situation that can cause the weakest of the terminal abutments to fail where parallel preparation might result in pulpal exposure. Such situations can be solved through the use of intracoronal attachments as connectors. which need to be splinted together with the fixed prosthesis
  • #53 the wax pattern for the middle retainer is first completed. Cut a keyway or Tshaped preparation in the distal surface of the wax pattern and cast it. After the prepared wax pattern has been cast return it to the working cast. form the key by placing acrylic resin in the keyway. After the acrylic key has polymerized, attach it to the wax pontic. The pontic wax pattern, incorporating the resin key, is then removed, invested, burned out, and cast.
  • #54 After the acrylic key has polymerized, attach it to the wax pontic. The pontic wax pattern, incorporating the resin key, is then removed, invested, burned out, and cast.
  • #55 keyway sliding over the key of the anterior retainer
  • #57 The wax pattern for the anterior three-unit segment (mesial retainer-pontic-pier retainer) is fabricated first, with a distal arm attached to the pier retainer
  • #58 Ney mini rest assembly can be used After the preparation of teeth is done according to their long axis, the mesial half of then retainer is fabricated and then the ney mini rest is attached to the surveryor to determine the alignment of attachment The anterior half is waxed and casted after which the posterior half is attached and casted separately
  • #60 Place a 0 7-mm-diameter pencil lead through the hole and build the wax pattern around the lead and the wing. Remove the lead, withdraw the retainer-pontic wax pattern, and replace the 0.7-mm lead in the hole in the pontic pattern to maintain the patency of the hole during investing and casting. Assemble the two parts of the fixed partial denture on the working cast. Smooth hole through the pontic and wing
  • #63 Only lingual surfaces are prepared
  • #64  Initial concept of bone driven implant placement is replaced by restoration driven implant placement This concept mandates that implant be placed where one can achieve maximum functional and esthetic benefits.
  • #65 Rp4- overdenture with implants Rp5- overdenture supported by soft tissue and implants
  • #67  A metal framework is fabricated which attaches to the implants and which has been designed to incorporate mechanical elements to help retain acrylic resin and artificial denture teeth. An alternative option in such situations is the hybrid prosthesis.
  • #69 a review was done to regarding for tooth-implant supported prosthesis
  • #71 When FRC and particulate composite superstructures were used instead of metal and porcelain