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Introduction to Fixed Partial Dentures and

Bridge Connectors.
Mini--Residency 2012.
Mini
Associate Professor Harry Hughes BDSc Qld, DDS (Hons) Toronto, MS
Michigan.

IS THIS A SIMPLE SPACE MAINTAINER or

A DODGY BRIDGE ?????
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Fixed partial dentures

Ahmad Irfan. Protocols

for predictable asthetic
dental restorations. 2006,
232 pages, WileyBlackwell Publisher.

Definition:
A BRIDGE OR FIXED PARTIAL DENTURE is:
A prosthetic appliance permanently attached to some of the remaining teeth and
replacing a missing tooth or teeth

Ref: Smith BGN. Planning and making

crowns and bridges.
4th. Edition Martin Dunitz, U.K. 2006.
Also : Wise Michael. Failure in the
restored dentition. This book, published by
Quintessence Publishing in 1995 was
some 766 pages in length. I can only find
that it is now out of print.

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FIXED PARTIAL DENTURES

TYPES OF FPDs: There are six types of FPDS or bridges:
Fixed Fixed or Rigid bridge.
Fixed Free or Stress
Stress--broken bridge.

Cantilever bridge.

Spring Cantilever bridge.

Maryland or Resin retained bridge.

Hybrid bridge with Conventional retainer at one end
and a resin retained retainer at the other end.
The Hybrid application was for the virgin tooth at one
end of the space and the heavily restored tooth at the
other end. Many variations were described but all had
a poor success rate. 32% failure rate in 48 months.

Components of a bridge.

Ref: Anweigi LM, Ziada HM and Allen PF Clinical performance of hybrid bridges. J Oral
Rehabil 2007,34:4,2912007,34:4,291-296
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Abutment: A tooth serving as a support

for an FPD
Pontic:
The artificial tooth/teeth
suspended between the abutment teeth
Retainers: Restorations cemented to the
prepared abutment teeth
Connector: The join between the pontic and
retainers; either rigid or non-rigid
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Unfortunately, the days of using partial coverage gold alloy

crowns or even gold inlays for retention have long passed, yet
there are many cases where such bridges have lasted in excess of
50yrs. The case shown constructed off a gold crown lasted 53
yrs.

SUCCESS RATE WITH DENTAL BRIDGES.

The dental bridge has been regarded as the standard of care for
decades in the replacement of single and multiple missing teeth.
UNFORTUNATELY these days, the only types of bridges that
seem to be constructed are full coverage bridges, either metal
ceramic or all-ceramic, and that is a great pity because:

Reference:
Nasser U and Russett S. Longevity of a
maxillary 2unit cantilevered FPD: Clinical
report. J Can Dent Assoc 2006;72(3):253-55

1. To obtain optimal functional and esthetic results for metalceramic bridges and all-ceramic bridges, very significant amounts
of tooth structure must be removed, especially if the abutment
teeth are not parallel .
2. This significant tooth removal has the potential to create
endodontic, periodontic, and structural complications, ( and
certainly to me, sleepless nights.)
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With partial coverage, the abutment preparation design can be

tailored to restrict tooth preparation excesses (the infamous teepee
preparation,) depending on the occlusion of the case and the
esthetics desired. Resin cement has helped in these cases of partial
coverage and anterior guidance is easier to RE-ESTABLISH. The
result can be esthetic without the underlying metal shadow, as
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shown
in the next slide..

Many studies surveying the long-term survival of

dental bridges have been compiled and analyzed to
arrive at a generalized outcome.
When a broad definition of failure was used combining
bridges already removed with those that had
technically failed and needed replacement; 87% and
69% were estimated to survive at 10 and 15 years
respectively. (Scurria et al. 1998.)

In this case a pinledge preparation, one

of my absolute favorites, was used on
the cuspid abutment.
The result was pleasing and this case
was prior to the introduction of the
ovate pontic which would have
improved the esthetics even more.

It is now generally accepted that bridge survival is

approximately 87% at 10 years, dropping to 69% at 15
years.

Reference:
Hughes H J Are there alternatives to the
porcelain fused to gold alloy bridge ? Austral.
D J 1970;15(4):281-287.
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In Australia, Walton , 2002, looked at 515 metal ceramic bridges

longitudinally over 15 years and reported similar survival rates.

And then there is the problem of the selection of an

abutment tooth:
There have been numerous studies showing that endodontically
treated anterior teeth are predisposed to long-term failure as
bridge abutments. Pier abutments also fall into this category
and their problem will be discussed in depth later. (Foster
1991.)

References:
1. Scurria MS et al. Meta-analysis of fixed partial denture survival: prostheses and
abutments. J Prosthet Dent. 1998;79:459
2. Foster LV. The relationship between failure and design in conventional bridgework. J
Oral Rehabib. 1991;18:491
3. Majorana A et al. Root resorption in dental trauma: 45 cases followed for 5yrs.Dent
Tramautol. 2003;19:262.
4. Walton TR. An up to 15 yr. longitudinal study of 515 metal-ceramic FPDs. Part 1:
outcome. Int J Prosthodont. 2002;15:439.

General indications for a Dental Bridge.

Additionally, prospective abutment teeth that were subject to
luxation or avulsion injuries, (Majorana et al. 2003,) are at
significant risk of requiring future endodontic treatment and
would be a poor abutment choice .
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As a general statement dental bridges should only be used for

the replacement of a single or 2 missing teeth, and, according to
the Textbooks on Crown and Bridgework; should use
abutment teeth that have an equal or greater root surface area
to the area being replaced (Antes law 1926).
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Abutment teeth

Abutment teeth

3. Vital teeth THE TEXTBOOKS SAY:

: If vitality in doubt- root treat, then use.
HARRY SAYS: : If root treated, always use a cast
post-core with ferrule and a gold alloy cervical collar on
the crown and only use in short span bridges. But really,
if non-vital teeth are used expect a decreased life
expectancy regardless of span length.

PRE-REQUISITES FOR A SUCCESSFUL ABUTMENT

TOOTH.

1. Absence or no history of periodontitis

: Maximum bony support
: Healthy gingival tissue, no gingivitis
2. Large root surface area and configuration
: Multi-rooted teeth with wide root separation
: Long roots that are wide bucco-lingually
: No short, conical roots
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Walton TR. An up to 15 yr longitudinal study of 515 metal ceramic FPDs. Part 1 Outcome. Int J
Prosthodont..2002;15:5,439

4. Sufficient remaining tooth structure on the proposed

abutment tooth.
: Virgin teeth are best, but can you do it??? This is
where the Hybrid Bridge already mentioned, was born
: Avoid heavily restored teeth
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Abutment teeth

5. A favorable crown/root ratio with an absolute

minimum of 1:1
ANTES LAW states the root surface area of the abutment
teeth should equal or surpass the root surface area of the teeth
being replaced by pontics.
This old law must be interpreted generously. Remember that
Antes Law was suggested in 1926, when the cause of
periodontal disease was largely unknown and occlusal
understanding and concepts were based around complete
denture practice. In the light of current knowledge is it overly
cautious???
There is no set level of gingival attachment below which the
use of a tooth as an abutment becomes contra-indicated;
however, the remaining support must be healthy and the
occlusion controlled with no parafunction.

The best: Canines and First molars

The worst: Mandibular and maxillary

Read: Nyman and Ericsson. The capacity of reduced periodontal

tissues to support fixed bridgework. J Clin Periodont 1982,9:409

lateral incisors
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Pontics

Pontic design

Pontic design
: Hygienic
: Modified ridge lap

: Ovate (Although first described in 1933, the ovate pontic was not
.)

really used much before the late 1990s

Zitzmann et al. The ovate pontic design: A histologic observation in humans. J Prosthet
Dent. 2002;88:375-380
Dylina TJ. Contour determination for ovate pontics. J Prosthet Dent. 1999;82:136-142

Modifedridge lap

: Ridge lap or Saddle

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Ridge lap
(saddle)

Hygienic

Worst

Best

Ovate
USED MAINLY IN
THE ANTERIOR
PART OF THE
MOUTH FOR
ESTHETICS AND
MAINTENANCE 18
REASONS

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Cast is scored with a round #3

bur.

UNIQUE OVATE PONTIC DESIGN.

Kim HK, Caseione D. and Knezevic A. Simulated tissue using a unique
pontic design. A clinical report. J Prosthet Dent 2009; 102:4, 205.

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Pontics

The law of BEAMS.

Pontics

Flexure length3

Pontic number: Determines bridge type

: single pontic - short span bridge.
: multiple pontics - long span bridge.

Flexure depth3

Law of Beams (Brumfields Law)-

Deflection varies directly with the cube of

the length of the span and inversely with the cube of the occlusogingival thickness of the
pontic.
Force on a one pontic bridge = Distance between the abutments. Same force on a 2 pontic
bridge = 8xDistance. Same force on a 3 pontic bridge = 27xDistance. Technically, this
should influence abutment design, number of abutments, and the design of FPD connectors.
Smyd E S. The role of torque, tension and bending in Prosthodontic failures. J
Prosthet Dent 1961;11:95-111

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RETAINERS

DOUBLE ABUTTING.

The retainer selection is dictated by:

Length of the edentulous span
Long spans are less rigid. All bridges bend during function and so
does the mandible. See the LAW of BEAMS.
Dislodging forces tend to act mesiodistally on a bridge as opposed to
the mainly buccolingual forces on crowns. Preparations should be
modified accordingly with accessory retention boxes, grooves,
pins, etc.

Periodontal support
and Double Abutting

The older literature states that double abutting is often used to
overcome both unfavorable crown/root ratios and long span
retention.
The secondary abutment must have a similar carrying capacity to the
primary abutment and the retainers on these secondary
abutments must be as retentive as the primary abutment
preparation.
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Even many current Textbooks on Fixed Prosthodontics still

recommend multiple abutments as a means of tying in the
prosthesis. Double abutments are also described as a means of
increasing the retention of the prosthesis.

Their use on these grounds is mistaken.

Fixed bridges are much more at risk of failure due to inadequate

resistance, i.e. being twisted or torqued off the abutment teeth.
Thus, double abutments increase retention but decrease
resistance, thereby increasing the risk of failure of the bridge
through loss of cementation of the secondary retainer as the
primary abutment becomes a fulcrum.

There is also no evidence that the use of a second abutment will

protect a weakened one.

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RETAINERS

RETAINERS
Thus, double abutments are out of favor in modern crown and
bridge design, (Foster 1991, Ibbetson et al. 1999,) and posterior
bridge units tend to be stress-broken to permit some vertical
movement in the posterior section of the bridge. This stress
breaking applies to both maxillary and mandibular posterior
bridges.
Because of the curvature of the dental arch, anterior bridges tend
to be rigidly constructed.
Arch Position of the Teeth.
When the pontic(s) lies outside the inter-abutment axis as in the
replacement of maxillary anterior teeth, the pontic(s) will act as
a lever arm producing torque to the bridge. This is a common
problem in replacing all four maxillary incisor teeth with an
FPD, and is most pronounced in the arch that is pointed in the
anterior region. To offset this problem it was suggested that
additional retention be gained in the opposite direction from the
lever arm at a distance from the inter-abutment axis equal to the
length of the lever arm; by double abutting.
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It used to be thought that double abutting was necessary in

these cases, but modern design only singularly abuts in
most cases, unless the arch curvature is excessive.
Two of the problems with double abutting are 1. the difficulty
with oral hygiene caused by the interproximal connector
and 2. the problems of parallelism of the multiple abutment
teeth. It is further suggested that stressstress-breaking is
unnecessary in anterior bridges because anterior bridges
receive less stress than posterior bridges.
Markley K., J Prosthet Dent.1951,1:416Dent.1951,1:416-423.

These bridges had excellent success

with an average lifespan in excess of
10.6 years. Walton J et al. 1986

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Connectors
Retainers
CLASSIFICATION:
Crown type
: Full crowns
: Partial crowns- must at least be three quarter
crowns. Onlays and inlays have insufficient
retention, (or do they ???)
: Maryland retainers
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To stress-break or not to stress-break, that is the

question!!
What about all ceramic
bridges?
Maxillary FPDs
Obviously they cant
Anterior
: fixed
be stress broken so I do
Posterior
: fixed-free not feel a use for them
in the posterior mouth.

Mandibular FPDs:
More on all-ceramic
Anterior
: Fixed
bridges later.
Posterior
: Fixed-free i.e. Fixed at the posterior
connector and stress broken at the anterior connector.
Now, it is becoming more common to stress break
ALL POSTERIOR BRIDGES.

CONNECTORS

CONNECTORS
Remember that connectors are that portion of the bridge that unites the
retainers and the pontics. They are of two types, rigid connectors and
non-rigid connectors (NRCs).

The occlusal forces applied to a fixed partial denture (FPD) are

transmitted to the supporting structures through the pontic, the
connectors, and the retainers.

Variables that may influence the longevity of a bridge and its

abutments include the occlusion, span length, bone loss, and
the quality of periodontium.
The excessive flexing of the long-span FPD, which varies with the
length of the span cubed, can lead to material failure of the prosthesis
or to an unfavorable tissue/bone response.

Biomechanical factors such as occlusal overload, leverage,

torque, and flexing, induce abnormal stress concentration in an
FPD.
This stress concentration is found in the connectors of the bridge
and in the cervical dentin area near the edentulous ridge. This factor
plays an important role in the potential for failure, particularly in
long-span bridge.
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Rigid connector could be made by casting, soldering, and welding. The

cast connectors should be properly shaped in wax patterns. The
soldered connectors are made by fusion of an intermediate metal alloy
to the previously made castings. These days, the one piece casting goes
a long way towards overcoming rigid connector failure in bridgework.
The connector that permits limited movement between the otherwise
rigid members of the FPDs, is the Non- Rigid Connector or NCR .
The NRC could be made by an incorporation of prefabricated
precision inserts, by use of a custom-milling machine or by use of the
prefabricated plastic patterns.
Ref. Pissiotis AL, Michalakis KX. An esthetic and hygienic approach to the use of
intracoronal attachments as interlocks in fixed prosthodontics. J Prosthet Dent
1998;79:347-9

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NON-RIGID CONNECTORS.
4. Long span FPDs: which can distort due to shrinkage and pull of
porcelain on thin sections of framework and thus affect the fitting
of the prosthesis on the teeth. Again, should long span bridges be
favored considering their failure rate and considering the success
rate of implants ???

The indications for the use of the NRC in fixed prosthodontics are :
1. The existence of a Pier abutment , which promotes a fulcrum-like
situation that can cause the weakest of the terminal abutments to fail
and may also cause intrusion of the pier abutment. But should Pier
Abutments be used at all considering their high failure rate ??? (Ziada

et al. 1998.)

5. In situations where a questionable distal abutment exists and

fabrication of the fixed partial denture is considered to be the best
interim treatment, the use of the NRC may solve the problem of not
having to repeat the restoration of the remaining abutment(s) after
final failure of the questionable abutment.

2. The existence of a malaligned abutment , where parallelling

preparations might result in excessive tooth preparation and
devitalisation. Such situations can be solved through the use of
intracoronal attachments as connectors.
3. The presence of mobile teeth , which need to be splinted together
with the fixed prosthesis. In such situations, it is not practical to
cement a splinting type restoration with numerous teeth involved.
Through the use of interlocks, smaller segments can be cemented with
the splinting effect provided by the interlocks.

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6. It could also be used with osseointegrated implants.

So, the NRCs are mainly used to reduce stress on the

abutment and to accommodate malaligned FPD
abutments.
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The four types of NRCs are the

CONNECTORS

1. Dovetail (key-keyway) or (Tenon-Mortise) connectors.

Sutherland et al. (1980) suggested that a rigid bridge

resolves more of its stress internally before the
remaining stress can reach the bone, and it has been
found that the greatest stress concentrations in a rigid
bridge occur in the connectors. With a nonnon-rigid
design, the stress may be directed through the
abutment teeth to the supporting bone rather than
being concentrated in the connector itself.

This means that the prosthetic material and the luting

cement in a rigid design must withstand much greater
stress than in the nonnon-rigid design.

2. Loop connectors.
3. Split connectors.
4. Cross pin and wing connectors.
Align the path of the keyway to that of the mesial abutment. A
deep wax box is carved into the distal of the wax pattern for the
incorporation of a keyway, which in turn requires an intracoronal
preparation of adequate depth and a parallel path of insertion.
Ref: Badwalk PV, Pakhan AJ. Non-rigid connectors in Fixed

Prosthodontics: current concepts. J Indian Dent Assoc. 2005;5:2,99-102

Banjaree S. et al Non-rigid connectors- the wand to reduce stresses on the
abutment teeth. Contemp Clin Dent 2011,2:351.
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CONNECTORS

Connectors

Another problem that exists in the posterior mouth is the

inequality of the abutment tooth size.
In a bridge replacing a first molar for example, the smaller
abutment (second premolar) may develop a thicker pericemental
cushion following frequent stress, as a compensating measure for
this stress. As a result, weaker abutments may move more than
the larger sturdier abutment. This results in large lever strains on
the weaker abutment which tends to shear the luting bond.
However, when a stressstress-breaker is used on the smaller abutment,
it will tend to dissipate much of the leverage force.
Stress--breakers can also be required in long
Stress
long--span bridges as
satisfactory tooth alignment becomes more difficult to achieve.
Even in shortshort-span bridges with divergent abutment teeth,
abutment preparations do not have to be parallel to each other.
Each preparations can be designed to MAXIMIZE individual
retention, independent of a common path of insertion.

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35

The use of stress-breakers also tends to break up bridge length to more

manageable portions and makes subsequent repair/replacement easier.

Fixed-fixed
Rigid connectors
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Fixed Free
Stress broken connectors.
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Connectors

P
P
P

Stress-breakers
SEVEN UNIT BRIDGE BROKEN INTO
MANAGEABLE UNITS.
Precision, semi-precision type attachment
Rest and seat

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EXAMPLES OF NON-RIGID OR STRESS

BROKEN POSTERIOR BRIDGES.
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THE PIER ABUTMENT.

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Unfortunately, the pier

abutment is a real
problem in FPD design.
The highest stress values were located at
connectors and cervical regions
of abutment teeth, especially at the pier
abutment.
Diagram shows the pier abutment acting as
a fulcrum in bridge loading. It is suggested
that a NRC in the distal of the abutment and
the mesial of the pontic will help dissipate
stress in the pier abutment.
Ref.:
Oruc S et al. Stress analysis of effects of
NRC on FPDs with pier abutments. J
Prosthet Dent 2008;99:3,185-192

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PIER ABUTMENT
These movements of measurable magnitude and in divergent
directions can create stresses in a long span prosthesis, which will be
transferred to the abutments.

PIER ABUTMENTS
Ref: Shillingburg/Hobo/Whitsett. Fundamentals of Fixed Prosthodontics, Second
Edition pages 25-29.

In many

instances, an edentulous space will occur on both sides

of a tooth, creating a lone, freestanding pier abutment.
Physiologic tooth movement, arch position of the abutments, and
the retentive capacity of the retainers make rigid, soldered five
unit bridges a less than ideal plan of treatment.
Studies in tooth movement have shown that the buccolingual
movement ranges from 56 microns, and intrusion is 28 microns.
Teeth in different segments of the arch move in different
directions.
Because of the curvature of the arch, the movement of an
anterior tooth in a faciolingual direction occurs at a much
greater angle when compared to the buccolingual movement of a
molar.
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Because of the great length through which movement occurs, the independent
direction and magnitude of movements of the abutment teeth, and the tendency
of the pier abutment to act as a fulcrum; considerable stress will be generated in
the abutment teeth.

The use of a non-rigid connector can lessen these hazards.

In spite of an apparent accurate fit of the bridge, the movement allowed by this
type of connector is enough to prevent the middle abutment from serving as a
fulcrum in a buccolingual or occclusocervical direction.
The non-rigid connector is a broken-stress mechanical union of retainer and
pontic, instead of the usual rigid joint. The keyway of the connector should be
placed within the normal distal contours of the middle abutment and the key
should be placed on the mesial side of the first molar pontic.

The nonrigid connector is also a solution to the problem of the

tilted
FPD abutment.
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THE REPLACEMENT OF A MISSING CANINE.

The canine tooth is often the keystone of the Dental Arch and a
very difficult tooth to replace using a bridge.
The adjacent teeth are very poor in terms of the amount of
retention and support that they can offer and the canine is often
subject to enormous stresses in lateral excursions particularly in
canine guided occlusions.
If the canine is to be replaced with a bridge, the occlusal scheme
should be redesigned to provide group function, NEVER a
CANINE PROTECTED OCCLUSION.
Canine replacement is best done by using

44

Mandibular FPD
FPDs
3 unit FPD replacing a lower 6

an implant.

There is a very good article by Hemmings and Harrington, 2004, that

describes the treatment options for the edentulous space , to-gather with
reasons for the choice of the replacement recommended. It is well worth a
read.
Hemmings K and Harrington Z. Replacement of missing teeth with fixed
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prostheses.
Dent Update;2004,31:137-1241.

Tilted 2nd molar

45

3 unit FPD replacing a lower 6

Over-erupted opposing
molar

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1. A 3 unit FPD replacing a lower 6

Remember that I
would stress-break
ALL posterior
bridges.

CROWN OR
RE-SHAPE
THE
OCCLUSAL
SURFACE of
the over
erupted
opposing molar

BRIDGE CONSTRUCTED WITHOUT ATTENTION TO THE OCCLUSAL

Level the occlusal plane

PLANE
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Provide Anterior guidance

3 unit FPD replacing a lower 6

1: Organise the occlusion

GROUP FUNCTION

: Even out the occlusal plane

: Remove tooth prematurities to CR
: Provide anterior guidance, preferably cuspid
protection

ICP

2: Fabricate the mandibular FPD

RESHAPE CUSPID- CUSPID PROTECTED

with a NRC.

3: Institute a Post-op OHI and

maintenance program
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2. Mandibular FPD
FPDs The heavily tilted
molar

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Mandibular FPD
FPDs
1. Prepare 2 full crowns for FPD
THE TEEPEE PREPARATION.

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1: Possible pulp exposure

2: Poor retention
3: Difficult path of insertion

1: Elective RCT
2: Recontour mesial lower 7
3: Methods of retention
: crown lengthening
: retentive devices
(grooves, boxes etc) are
indispensible

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Mandibular FPD
FPDs

Mandibular FPD
FPDs

2. Prepare 2 full crowns after placing a

telescopic crown on lower second molar

3. Prepare partial crown for distal

abutment
1: Poor retention
2: High failure rate

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High failure rate

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Mandibular FPD
FPDs
Mandibular FPD
FPDs

5. Use fixed-free design (a NCR.)

1:Abutments prepared separately

4. Orthodontically upright lower 7

thereby
Maximizing retention on each
preparation.

THE BEST APPROACH BUT we must consider:

: no pulp exposure
1: Cost
2: Time

2: 2 separate paths of
insertion
THE SECOND BEST
TREATMENT APPROACH.
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3: NRC counteracts
mandibular flexure
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Mandibular FPD
FPDs Summary
1: Occlusal Control: Reorganize occlusion to cuspid
protected if possible

2: FPD

: 2 abutments only and avoid long spans.

: no double abutments
: full crown preparations with boxes etc.
particularly in posterior bridges.
: fixed at distal end
: stress broken at mesial end
: supra or equi-gingival abutment margins
: hygienic pontic in the posterior arch
: avoid non-vital teeth and pier abutments

3: Pre and post-op oral hygiene

instruction
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BADLY DESIGNED
HYGIENIC PONTICS

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TWO ANTERIOR THREE UNIT BRIDGES

Different materials in
occlusal contact.

EXTENSIVE BONE AND

SOFT TISSUE LOSS.

NOTE THE LENGTHENED AND

RESHAPED MAXILLARY AND
MANDIBULAR CUSPIDS TO CREATE
CUSPID DISCLUSION.

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60

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Implant: Single tooth in particular with virgin teeth

Spring cantilever
Bridge had the longest success rate

as potential abutments

(25 + yrs) in one study but was dismissed

because it belonged to another

era.

Boy, where does that put me !!!!

Maryland bridge
The days of DENTAL GLUE ??

There is absolutely reams written on

these bridges in the literature

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MARYLAND BRIDGE

MARYLAND BRIDGE FAILURE

CAN PROSTHODONTICS GET ANY MORE INTERESTING THAN THIS ???

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BRIDGE FAILURES

Ref: Foster LV Relationship between failure and design in

conventional bridgework. J Oral Rehabil. 1991,18:6,491-495
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Failure in bridgework is difficult to forecast. Different studies

draw conflicting conclusions. Average lifespan of fixed
restorations are anywhere between 10-21 years plus. Success
probably depends on adequate diagnosis, caries control, as well
as radiographic, clinical and laboratory QUALITY control
procedures and oral hygiene.
Bridges with 3 or more abutments have a greater chance of
failure than those with only 2 abutments. Bridges with 2 or more
pontics have a similar lower survival rate. (See next slide.)
Ref. 1. Walton T. A survey of crown and fixed partial denture
failures:length of service and reasons for replacement. J Prosthet
Dent. 1986;56:416-421.
2. Scurria. Meta-analysis of fixed partial denture
survival:prostheses and abutments. J Prosthet Dent. 1998;79:459464.
3. Holm C. et al. Longevity and quality of FPDs:a retrospective
study of restorations 30, 20 and 10 years after insertion. Int J
Prosthodont. 2003;16:283-289.

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Some recent findings:

The overall survival estimation for Short-span FDPs
was statistically MUCH better than for Long-span
FDPs at year 20. The use of an RCT abutment becomes
more significant in fixed prosthetic restorations with 4
or more units.
De Backer et al. Int J Prosthodont 2008;21:7585.

There was no statistically significant difference in the long-term

survival of 3-unit FDPs on vital abutments versus those with at
least 1 RCT abutment. For FDPs with more than 3 units and
Cantilevered-FDPs, the use of a post-and-core abutment led to
significantly more failures.
De Backer et al. Int J Prosthodont 2007;20:229234

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During the past 3 decades, dentists have been

placing non-metallic bridges made of all ceramic
materials (They have been constructed of many
different types of materials, including: feldspathic
porcelain, leucite-reinforced glass ceramic,
aluminum oxide, lithium disilicate, and, most
recently, zirconium oxide.
The feldspathic bridges (1983) were not very strong
and were prone to fracture in both the anterior and
posterior regions of the mouth. It was not until
pressed leucite-reinforced ceramic (1993) began to
be used for anterior bridges that any degree of
success was attained.

Metal cervical collars on preparations if

possible.
Metal occlusal surfaces
Post cementation radiograph.
Dental hygiene follow-ups.
Avoid root filled teeth and pier abutments.
Avoid anterior bridges in general except the
six unit anterior bridge off two suitable
canines,

Finally, a little data on all-ceramic

non-metal bridges.
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Other stronger ceramics have been tried as frameworks,

such as aluminum oxide, and a newer material called
lithium disilicate (1998) (pressed or CAD/CAM), but
studies have shown that these had a higher failure rate
than when zirconia was used.
Zirconia crowns (2003) and bridges are the newest
addition to the clinicians choices for a non-metallic
restoration . Sailer 2007, recently completed a study of
57 three- to five-unit posterior zirconia bridges in 45
subjects where CAD/CAM frameworks were veneered
with porcelain and cemented with resin cement.
At the 5-year recall, only 33 of the bridges were left and
12 of those needed to be replaced. Marginal gaps were
found in almost 60% of the cases with secondary caries.
Only 3% of the frameworks fractured, but 15.2% of the
bridges had fracturing of the surface porcelain.
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Non-Metallic or All-Ceramic Bridges

Bridge failures

BRIDGE FAILURES
It must be remembered that the length of service of a
fixed partial denture is not only dependent on the
number of years in service, but of specific procedures and
routine recall appointments that can increase the length
of service of the restoration.

Ref. Libby G. Longevity of fixed partial dentures. J Prosthet
Dent. 1997;78,2127-31.
Here are some of Libbys suggested procedures to improve
the length of service of a fixed partial denture:

Pretreatment periapical radiographs of all abutment teeth.

Removal of all pre-existing restorations and bases, unless
placed by you.

Use of high content gold alloys.

Shoulder preparation as finish lines.

Margins placed at or coronal to the gingival crest

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Chipping of the veneered porcelain has been a common

problem with zirconia frameworks. Swain 2009, has reported
that the unstable chipping of the veneering porcelain could
be caused by the difference in the thermo-elastic properties
between the zirconia frameworks and the veneering material.
Two-year results in an ongoing clinical study by Clinicians
Report 2008, comparing PFM bridges with those made from a
zirconia framework revealed "external ceramic fractures were
five times more prevalent with ceramic formulations used on
zirconia versus those used on metal." This study also
showed that 48% of the bridges had chips, 45% had surface
degradation, 7% had cracks, and 1% had delamination. Unlike
PFM, there has been little research done with the
zirconia/porcelain combination
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Many articles are now appearing in various journals

studying all aspects of zirconia crowns and bridges, such
as: bond strengths to different types of zirconia, the effect
of various surface treatmentsincluding hydrochloric
acidon the bond strength between the zirconia and the
veneering porcelain, as well as preparation design, which
has been recommended by Beyer et al. 2008, to be a
shoulder.
References.
1.Swain MV. Unstable cracking (chipping) of veneer porcelain on allceramic dental crowns and bridges. Acta Biomater,2009;5:1668-1677.
2.Christensen GJ. Clinicians report (on line) 2008;1(11)
3.Beyer F. et al. Effect of preparation design on the fracture resistance
of zirconia crown copings. Dent Mater J 2008;27:362-367.
4.Small BW. Fixed partial dentures. Inside Dentistry,2011;7:4.
5. Sailer I. et al. Five year clinical results of zirconia framework for
posterior FPDs. Int J Prosthodont.2007;20:383-388.
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AN INTERESTING
BRIDGE CASE (1999)
PRESENTED TO 55
POST-GRADUATE
DENTISTS IN THE UK.
65% RESPONDED TO
THE QUESTIONS
ASKED.
THE RESPONSES WERE
BOTH INTERESTING
AND ENLIGHTENING
OR SHOULD THAT BE
FRIGHTENING,
PARTICULARLY FOR
ME AS AN ACADEMIC.

THANK YOU SO MUCH FOR YOUR

ATTENTION.

THE FINAL BRIDGE

DESIGN IS BATHED IN
CONTROVERSY AS FAR
AS I AM CONCERNED.

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WE WILL ONLY CONCENTRATE ON

1.

CHOICE OF ABUTMENT TEETH

2.

NUMBER OF PONTICS
3. TYPES OF RETAINERS
4. TYPES OF
CONNECTORS
5. OPPOSING TEETH
CONSIDERATIONS

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