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Abutment Selection in Fixed Partial Denture - A Review: Drug Invention Today January 2018
Abutment Selection in Fixed Partial Denture - A Review: Drug Invention Today January 2018
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Ashish R Jain
Tamil Nadu Dr. M.G.R. Medical University
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ABSTRACT
Fixed partial denture (FPD) replacements for teeth have taken a variety of designs throughout the years. Many principles
involved in the preparation and construction of fixed prostheses are still dominating, although more compatible and resilient
materials have been introduced in recent years. FPD transmits forces through the abutment to the periodontium. Failures
are due to poor engineering, use of improper material, inadequate tooth preparation and faulty fabrications. Therefore, it
is important to select abutment in FPD. The clinicians must recognize the forces developed by the oral mechanism and the
resistance of the tooth and its supporting structures to them. This article will review the conditions and requisites for the
selection of abutment for FPDs for the long-term success of fixed dental prosthesis.
KEY WORDS: Abutment, Crown root ratio, Fixed prosthesis, Occlusal anatomy, Surface area
Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha University, Chennai, Tamil Nadu, India
*Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital,
Saveetha University, Poonamalle High Road, Chennai – 600 077, Tamil Nadu, India. Phone: +91-9884233423.
E-mail: dr.ashishjain_r@yahoo.com
morphology, pulp outline, the periodontal ligament and lingual form to the height of contour [Figur 5].
space, the alveolar bone, infrabony defects, residual Reducing the width of the pontics does not materially
roots, impacted or supernumerary teeth, and the extent reduces the force transmitted to the abutments, but
of present or past caries. Peripheral and bitewing films merely places heavier per unit stress on the restoration
are most important in the selection of abutment teeth and produces conditions in the pontic.[6,9,10]
[Figure 2].[9] It also helps in assessment of crown root
ratio, pulpal status, and periapical status.[9-11] Arch Form
Parfitt (1960) have shown that the faciolingual
Crown Root Ratio movement ranges between 56 µm and 108 µm, and
This ratio is the measure of the length of tooth, intrusion of 28 µm. Teeth in different segments of the
occlusal to the crest of alveolar bone compared with arch move in different directions. Due to the curvature
the length of tooth embedded into the bone. As the of the arch, the faciolingual movement of an anterior
level of alveolar bone moves apically, the lever arm tooth occurs at a considerable angle to the faciolingual
of that position out of the bone increases and the movement of the molar.[3] Restorations involving
chances of harmful lateral force increases [Figure 3]. anterior teeth are shaped in the form of any arc.
A prosthodontic textbook considers a (CRR) Crown When forces are applied to the pontics, a rotational
Root Ratio for an FPD abutment of 1:2 to be ideal, effect occurs on the abutments, and a vertical force
but in practice, this is rarely observed.[4] An optimum is exerted on the terminal ends of the fixed partial
crown root ratio for an abutment is 2:3. The ratio of denture.[7] The lever arm is determined by drawing a
1:1 is the minimum ratio acceptable for abutment perpendicular line from the fulcrum line to the point
under normal circumstances. The CRR definition has on the pontics farthest from this line [Figure 6]. The
several inherent shortcomings. The ratio is based on fulcrum is a line joining the abutments adjacent to
linear measurements only; however, when evaluating the edentulous space at the proximo-occlusal angles
abutment teeth, the clinician should assess the status of the preparation. The greatest leverage occurs when
of the alveolar bone height and the total supported root the four maxillary incisors are replaced in a narrow
surface of the abutment tooth.[7] Dykema, suggested tapered arch. The presence of a single incisor will
a ratio of 1:1.5 as an acceptable and desirable CRR considerably shorten the lever arm. A long lever arm
for abutments, although the authors state that the less can be equalized by using additional abutments. The
favorable proportion may be acceptable when the first premolars sometimes are used as secondary
periodontium is in healthy condition, and the occlusion abutments for a maxillary four pontic canine to the
is controlled.[5,7] The longer the edentulous span and canine fixed partial denture.[12,13,17] Due to the tensile
the greater the torques on the abutment teeth, the more forces that will be applied to the premolar retainers,
favorable the crown-to-root ratio must be. The use of they must have excellent retention.
multiple abutments can sometimes compensate for
poor crown-to-root ratios or for a long span.[7,12] Occlusal Anatomy
Occlusal anatomy has an indirect influence on loads
Periodontal Surface Area transmitted. The ridges and grooves increase the
Introduced by Ante (1926) and later by Johnston sharpness and shearing action of teeth and reduce
et al. (1971). The combined pericemental area of the friction between the opposing surfaces by keeping the
abutment teeth should be equal to or greater to the contact area to the minimum. This permits the most
pericemental area than the teeth to be replaced (Ante’s efficient mastication and reduces the load transmitted.
Law).[13,14] In the case, where the periodontal surface area Stallard points out that worn down teeth need more
is inadequate, the multiple teeth abutment is indicated muscular power and longer and more masticatory
depending on other biomechanical factors.[13] The total strokes to chew food enough.[18,19] Much of this force
mesiodistal width of the cusps of abutments should is directed at right angles to the long axis of the teeth.
equal or exceed the width of the cusps of points. This Properly articulated ridge bearing cusps will cut the
relationship assures that the occlusal load transmitted food rapidly, with fewer strokes, with much less
to the abutment teeth will not be more than twice the muscular effort, and will direct most of the closure
amount normally supported by these teeth individually forces perpendicularly in line with the long axis of the
[Figure 4]. Larger teeth have greater surface area and teeth [Figure 7].
are better able to bear added stresses. The areas of
various teeth are reported by Marcum.[13-16] Root Configuration
This is an important assessment of abutment’ suitability
Buccolingual Dimensions of Tooth from periodontal standpoint. The tooth with conical
The occlusal surface of the pontics should harmonize roots can be used for a short span if all other factors are
with the buccolingual dimension of the natural optimal [Figure 8]. Tooth with longer root is stronger
unmutilated teeth, and recreate the normal buccal abutments than short roots. Labiolingually conical
a b
c
Figure 3: (a) Ratio- 3:1 (not accepted), (b) ratio- 1:1 (least
accepted), (c) ratio- 2:3 (ideal)
Axial Alignment
The axial alignment is the long axis of the abutment
teeth to each other. A tilt up to 25° for full veneer
preparation and 15° for resin-bonded bridges.
Esthetics
Full coverage crown provides better esthetics and
retention. Anterior abutments with long connectors
also provide good esthetics.
a b
Pulpal Health
Vital teeth are often preferable due to better
proprioception. Inadequate pulpal heath can lead to poor
prognosis. Necessary treatment may be required before
restoration such as prophylactic root canal therapy.
Psychology c d
Mentally compromised patients may require multiple Figure 8: (a) Long root, (b) curved root, (c) straight root
(d) conical root
splintered abutments. Splinted abutments help to
distribute parafunctional forces.
diagnosis, and a realistic treatment plan that offers a
Phonetics favorable prognosis. A comprehensive, sequential
Abutment should not be bulky as it may affect the approach to treatment planning is essential. Planning
patient’s phonetics. for fixed prosthesis should not be independent of
other disciplines of dentistry. When planning and
Prognosis treating fixed prosthesis cases, it is important that all
A prosthesis should last for at least 60% of the time in the applicable parameters are taken into account. As
the span of 20 years. a suggested clinical guideline for the evaluation of
abutment teeth, the clinician should use the CRR, total
Mutilation alveolar bone support, root configuration, opposing
Sufficient abutment height of at least 4 mm should be occlusion, presence of a parafunctional habit, pulpal
present. Core build up with composite resins can be condition, presence of endodontic treatment, and the
done for tooth <4 mm occluso-gingivally. remaining tooth structure. Thus, this review provides
an overview of the factors influencing abutment
Mobility selection to facilitate long-term success of fixed dental
Teeth with Grade 1 mobility can be splinted with prosthesis.
additional abutments while teeth with Grade 2 mobility
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