Diagnostic Classification and Design Considerations for Implant-Supported Fixed Partial Dentures and Screw Access Channel: The ABC/PBC and SAC Classifications.

Logical categorization of implant-supported fixed partial dentures (ISFPDs) based on implant angulation, abutment type, and screw access channel (SAC) design for screw-retained restoration is not available in the literature. This article proposes a simple classification system to describe implant angulations and prosthesis design affecting abutment selection (engaging or nonengaging) for ISFPDs. An additional classification that addresses screw access channel designs is also introduced. These classifications provide clear interpretation of clinical scenarios for ISFPD design consideration and a basis for categorization of future complications. The angulation-based and prosthetic-based classifications simplify communication regarding implant angulation and prosthesis design type for ISFPDs. The SAC classification assists in prosthetic design, factoring in function and esthetics when designing the screw access.

Partial Edentulism based on Kennedy's classifcation: an epidemiological study.

BACKGROUND: The aim of this study was to determine the incidence of different Kennedy's classes of partial edentulism during 18 months period. MATERIALS AND METHODS: Patients were clinically examined for various Kennedy's classes of partial edentulism in the outpatient department (OPD), prosthodontics, GPRDCH, Kurnool (Andhra Pradesh). RESULTS: Of the total 1,420 OPD patients, Kennedy's class III was the most frequent classification encountered (62%) and followed by Kennedy's class I (18%), class II (11%), and class IV (9%) in decreasing order. CONCLUSION: The patients with various Kennedy's classes of partial edentulism can be offered various treatment modalities like removable cast partial dentures, fixed partial dentures, over dentures and implant supported dentures. This study can be crucial for screening the population for incidence of tooth loss as a factor of gender and age. Clinical significance: Tooth loss appears to have an important role in the loss of esthetics and mastication. Study of incidence of various classes of partial edentulism provides clinically useful information for dental training and continuing education.

Management of the single discoloured tooth. Part 2: Restorative options.

UNLABELLED: This is the second article of a two part series covering the aetiology, prevention and broad range of management options for the single discoloured tooth. The article covers situations where masking and simulation techniques with direct composite are required. Direct composite, indirect composite and ceramic veneers are then considered, as well as full coverage crowns. The option of extraction of the affected tooth and its prosthodontic replacement will also be considered. Clinical cases are used to illustrate various scenarios. CLINICAL RELEVANCE: The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and it is recommended that general dental practitioners consider adopting minimally invasive techniques in the first instance before moving on to more invasive therapies.

A 5-year retrospective study of cobalt-chromium-based fixed dental prostheses.

PURPOSE: The aim of this retrospective study was to evaluate the 5-year clinical outcome for ceramic veneered cobalt-chromium (Co-Cr) fixed dental prostheses (FDPs) fitted in a private clinical setting. MATERIALS AND METHODS: All patients treated consecutively with Co-Cr FDPs from January 2000 to November 2005 were included, and complications were registered. Patient records were examined for details on the restorations and abutment teeth. A total of 149 patients with 201 FDPs, 1,135 units, and 743 abutment teeth were recorded. RESULTS: Of the 149 patients, 122 (82%) were followed for 5 years. Complications occurred in 34 patients (23%) and 38 FDPs (19%). The most frequent were caries (6.7% of patients, 5% of FDPs, 2.2% of abutments) and cement failure (6.7% of patients, 5% of FDPs, 3.1% of abutments). Cohesive ceramic fractures occurred in only 7 FDPs (3.5% of FDPs, 0.7% of units). No adhesive ceramic fractures were recorded. The 5-year cumulative rates for success and survival were 83.8% and 92.8%, respectively. CONCLUSIONS: Co-Cr FDPs appear to be a promising prosthodontic treatment modality, presenting low incidence of complications and a high survival rate during the first 5 years of function. However, long-term randomized controlled studies are necessary to confirm these findings.

Risk of chipping or facings failure of metal ceramic fixed partial prostheses--a retrospective data record analysis.

This retrospective study investigated the frequency and time history of chipping or facings failure of three-unit and four-unit tooth-supported metal ceramic (MC) fixed partial prostheses (FPDs). Six hundred fifty-four MC FPDs were inserted according to a standardized treatment protocol at the Department of Prosthodontics of the Regensburg University Medical Center between 1984 and 2009. Frequency and time history of chipping or facings failure as well as possible risk factors were evaluated on the basis of historical clinical data. We estimated the survival times of FPDs by means of the Kaplan-Meier analysis. The 5-year survival rate (time to renewal of a FPD) of all MC FPDs was 94%; the 10-year survival rate was 87%. Twenty-eight (4.3%) MC FPDs showed chipping; the 5-year free-of-event rate of chipping was 95%, the 10-year rate was 94%. Possible risk factors had no statistically significant influence on chipping or facings failure. The annual hazard rate of MC chipping in the first year was 0.03, i.e., 3 out of 100 person-years of exposure showed chipping. The annual hazard rates for the next 6 years dropped to 0.009, 0.003, 0.007, 0.004, 0.005, and 0.007. Thus, about 3-9 out of 1,000 person-years of exposure showed chipping. Patients with MC FPD may expect a long survival rate of their restoration. During the first year, the risk of chipping may be higher than during the following years. Despite the long period of experience with MC FPDs, chipping of the facing will still occur.

Prótese fixa metal-free

Nos últimos anos, sistemas cerâmicos sem metal tornaram-se cada vez mais populares na prática odontológica, graças a uma estética superior, durabilidade química e biocompatibilidade...

Classification system for conventional crown and fixed partial denture failures.

The dental literature is replete with reports on the many aspects of failure encountered with traditional fixed prosthodontic treatment, including longitudinal survival studies of crowns and fixed partial dentures and reasons for failures. However, criteria for grading or classifying the type and severity of these failures are inadequate. A classification system for conventional fixed prosthodontic failures based on severity is presented.

A new design for all-ceramic inlay-retained fixed partial dentures: a report of 2 cases.

In a previous clinical study, all-ceramic resin-bonded 3-unit inlay-retained fixed partial dentures (IRFPDs) had a significantly worse outcome in the posterior region than did crown-retained 3-unit FPDs made from the same material. Debonding or fractures were causes of failure. To improve the clinical outcome of IRFPDs, a new framework design was developed: (1) The inlay retainers were made out of CAD/CAM-manufactured zirconia ceramic to improve fracture resistance, and additional veneering of the inlays was omitted. (2) The inlay retainers were completed with a shallow occlusal inlay (1-mm minimum thickness) and an oral retainer wing (0.6-mm minimum thickness). The wings were designed to reduce stress on the inlay retainer caused by torsion forces when the FPD is loaded nonaxially and to increase the enamel adhesive surface area. The pontic was circumferentially veneered with feldspathic porcelain. The clinical and laboratory procedures of this new treatment modality are described, and 2 exemplary clinical cases are presented. This new preparation and framework design might improve the clinical outcome of all-ceramic resin-bonded IRFPDs. However, adequate evidence of long-term safety and efficacy is required before this new design can be recommended for general clinical practice.

Failing four-unit maxillary fixed partial denture: part 2.

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. Part 1 presented pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of three treatment options: removable partial denture, tooth-supported FPD, and implant-supported FPD. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.

Avaliação das condutas adotadas por profissionais na utilização de coroas metalo-cerâmicas / Assessment of clinical proceedings adopted by dental professionals regarding the employment of ceramic fused to metal crowns

A fim de avaliar a opinião da classe odontológica sobre a utilização das coroas metalo-cerâmicas na prática odontológica, aplicou-se um questionário de 20 questões a cirurgiões-dentistas da cidade de Aracaju - SE, e a cirurgiões-dentistas e estudantes de pós-graduação em odontologia, na área de prótese dental, da cidade de Bauru-SP. Concluiu-se que: 1. As coroas metalo-cerâmicas são o tipo de restauração protética mais empregado em Odontologia. 2. A maioria dos dentistas refere-se às coroas metalo-cerâmicas como restaurações bem sucedidas, indicando superfícies oclusais metálicas para a maioria dos pacientes. 3. Apesar da maior parte dos profissionais utilizar as ligas de níquel-cromo nas coroas metalo-cerâmicas de seus pacientes, os mesmos prefeririam que ligas nobres ou semi-nobres fossem empregadas em suas próprias restaurações. 4. A maioria dos entrevistados emprega as coroas metalo-cerâmicas na restauração de dentes anteriores (57,23 por cento). Entretanto, esse valor se deve à preferência dos dentistas de Aracaju (78 por cento) por esse tipo de restauração, ao passo que, em Bauru, prevaleceu o número de respostas favoráveis às coroas de porcelana pura. 5. O cimento de fosfato de zinco foi o cimento de escolha da maioria dos profissionais. 6. A preferência da maior parte dos entrevistados, com relação à porcelana utilizada foi pela porcelana Vita (34,34 por cento), em comparação às porcelanas Noritake e Dulceram Plus (13,86 por cento). 6. Ficou evidente o desejo dos entrevistados quanto ao desenvolvimento de mecanismos que facilitem o reparo das coroas metalo-cerâmicas.

Implant-supported fixed cantilever prostheses in partially edentulous arches. A seven-year prospective study.

The purpose of the following study was to evaluate the medium- to long-term prognosis of implant-supported cantilever fixed prostheses, and to establish to what degree this is influenced by factors such as length, type of cantilever (mesial or distal), and opposite dentition versus cantilever prostheses. This study was performed on a sample of 38 partially edentulous patients treated between January 1994 and March 2001 with 49 partial cantilever fixed prostheses supported by 100 implants. Marginal bone resorption (MBL) has been studied and used as a reference parameter to define therapeutic success. The MBL measurement was made possible by transposing X-ray images of patients selected on a PC and then using a software program. Statistical analysis was carried out for possible correlation between peri-implant bone resorption and the parameters considered in this study: length and type (mesial or distal) of cantilever and opposite dentition to cantilever prostheses. Seven years after loading cantilever prostheses, the overall cumulative implant survival rate (OCSR) was 97%, and the prostheses success rate is 98%. Mesial cantilever prostheses registered a lower success rate (97.1%) than distal cantilever prostheses (100%). Furthermore, a better prognosis was not observed when the opposite dentition of the prostheses comprised natural teeth, or fixed prostheses on natural teeth, when compared with the cases in which opposite teeth were implant-supported fixed prostheses. The authors concluded that medium-term prognosis of implant-supported cantilever fixed prostheses and traditional implant-supported fixed prostheses was comparable. However, a thorough pre-treatment analysis of risk factors regarding implant-supported prosthesis survival is important.

Abutment positioning in a cantilevered shortened dental arch: a clinical report and static analysis.

This article describes the extension of a shortened dental arch with a cantilever fixed partial denture in a patient who refused to be treated with an implant-supported and retained prosthesis. Orthodontic movement of the distal abutment to enlarge the interabutment span was performed before the final restoration. The mechanical advantage of the enlarged span in a cantilever fixed partial denture is analyzed, discussed, and demonstrated by 2-dimensional static analysis.

Reabilitaçäo oral metal free: prótese parcial fixa adesiva cerâmica / Free metal oral rehabilitation: ceramic adhesive fixed partial prosthesis

Säo apresentados os procedimentos clínicos para a realizaçäo de uma prótese parcial fixa adesiva totalmente cerâmica de três elementos, com preparos dentais conservadores para a confecçäo de uma infra-estrutura de alumina infiltrada por vidro, através do sistema totalmente cerâmico In-Ceram (VITA)

Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease.

STATEMENT OF PROBLEM: Several choices exist for the treatment of advanced periodontal disease. One is a combined periodontal and prosthetic treatment that includes cross-arch fixed partial dentures (FPDs). However, the outcomes of such therapy have been reported mainly from studies in Scandinavian countries. PURPOSE: The aims of this study were: (1) to longitudinally evaluate, after periodontal and prosthodontic treatment that included cross-arch FPDs, treatment outcomes in Korean patients who suffered from severe periodontitis; and (2) to evaluate the patients' treatment assessments and the FPDs after 3 years. MATERIAL AND METHODS: This survey included 39 Korean patients provided with 50 FPDs. Clinical and radiographic examinations were performed at the time of delivery of the FPDs and at the 3-year follow-up examinations. The prostheses were divided into 3 groups according to design (end abutments, unilateral cantilever, and bilateral cantilevers) and the amount of supporting tissues at the time of insertion. On average, only 26% of the total original periodontal tissue remained at the time of insertion. The FPDs consisted of 11 to 14 units, with a mean of 5 to 7 abutments in the 3 groups. The mean periodontal ligament area of the abutments was 79% of the total ligament area of the replaced teeth. RESULTS: At the 3-year follow-up examination, the FPDs were stable in all patients, who in general displayed good oral hygiene and had healthy periodontal conditions. The change in periodontal ligament area over the 3-year observation period was negligible (1 mm(2) per dental unit) and showed no statistically significant difference in relation to FPD design. Most patients were satisfied with the function of their FPDs with respect to mastication, phonetics, hygiene, esthetics, and chewing comfort. A few patients stated that they were careful with the FPDs and avoided certain foods (for example, raw peanuts and grilled squid) because they felt insecure with the cantilever segments. Most patients reported that they would choose the same treatment again. CONCLUSION: Patients with advanced periodontal disease demonstrated successful outcomes over a 3-year period and reported satisfaction with combined periodontal and restorative treatment that included cross-arch FPDs.

Design principles for cantilevered resin-bonded fixed partial dentures.

Recent clinical studies show 2-unit cantilevered resin-bonded fixed partial dentures to be as retentive or more retentive than their fixed-fixed counterparts. The fact that the 2-unit prosthesis is successful adds value to the clinical use of resin-bonded fixed partial dentures because the single-abutment prosthesis is even simpler and more cost effective than fixed-fixed designs. However, there is no evidence-based information relating to design principles for abutment preparation and framework design for the single-abutment, single-retainer prosthesis. The aim of this report is to suggest principles of design for the 2-unit cantilevered fixed partial denture, based on information gained from studies on fixed-fixed designs.

PUENTE EN EXTENSION CON OMEGA

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Tooth stabilization and splinting before and after periodontal therapy with fixed partial dentures.

The design and use of fixed partial dentures as a definitive restoration to stabilize and splint teeth have been reviewed. The provisionalization of the splinted patient has been described as it is incorporated into the treatment plan of patients with a weakened periodontium. The current controversy of incorporating implants in the patient requiring splinting was discussed, and recommendations are made. Dentists are encouraged to explain all potential ramifications of splinting with fixed partial dentures, including cost, frequency of office visits, and potential alterations or remakes of the prosthesis should physiologic demands surpass the capabilities of the remaining teeth.

[Three-unit bridge prostheses. With or without crowns?]. / De driedelige brug. Met of zonder kronen?

Replacement of a single tooth by a fixed partial prosthesis is possible in several ways: a conventional bridge, a resin-bonded bridge or a UDA-bridge (Universal Dental Anchorage). Preservation of natural tooth substance, an optimal environment for the periodontal tissues and good esthetics are the main criteria for making a choice. Unrestored or minimally restored front teeth are an indication for a resin-bonded bridge. When an indication for a crown on the adjacent teeth is already present, a conventional bridge is the treatment of choice. Although the future promises metal free bridge solutions, the long-term prognosis of posterior bridges is best guaranteed by using metal-ceramic bridges. The UDA system requires improvement for general use.

[Application and survival rate of partial fixed dentures with combined retainers (adhesion wing, inlay, onlay, overlay, crown)]. / Kombinált elhorgonyzású (adhéziós kar, inlay, onlay, overlay, korona) rögzített fogpótlások alkalmazása és túlélésének vizsgálata.

Bridges at least with two types of retainers (adhesive frame-work, inlay, onlay, overlay, or crown) might be called fixed partial dentures with combined retainers. The aim of the present study was to compare the fixed partial dentures with combined retainers made at our clinic between 1986 and 1996. In our study the cumulative proportional survival of the combined bridges was found 80%. Examining the loss of the combined bridges it seems that in the first year 1% of the bridges came off. The rest was lost between 12th and 48th months.