The Resin-Bonded Fixed Partial Denture as the

First Treatment Consideration to Replace a Missing Tooth

Ruud Kuijs, DDS, PhD1/Andy van Dalen, DDS, PhD2/Joost Roeters, DDS, PhD3/Daniel Wismeijer, DDS, PhD4

The resin-bonded fixed partial denture (RB-FPD) is the first restorative treatment option
to be considered in cases where one or more teeth are missing. The indications for
implants, conventional FPDs, and adhesive FPDs, considering the general and dental
conditions of the patient, are discussed in this article. When the RB-FPD is the chosen
option, a direct or indirect technique, a cantilever-type or fixed-fixed design, and materials
to be used need to be selected. The choice will depend on a variety of factors, such as
interproximal space at the connector area, anterior or posterior location, the skills of
the dentist, esthetics, and the patient’s wishes. The RB-FPD can be made using various
techniques and materials. Int J Prosthodont 2016;29:337–339. doi: 10.11607/ijp.4412

W hen indicated, replacement of missing single

teeth can be accomplished in various ways. The
first determination to be made is whether the miss-
ing tooth really needs to be replaced. This decision
is reached in the context of several key determinants
—the patient’s wishes regarding improved esthetics
or function, local and systemic health considerations,
and patient age (as craniofacial growth impacts young
patients and may extend well beyond adolescence).
The presence of periodontal problems, the extent of
tooth wear, and the quality of the bone and teeth at
the site of the missing tooth will also influence the
treatment decision.
The current treatment preference for this prosth-
odontic challenge is dominated by an implant therapy
mindset, with the alternative options—a resin-bonded
fixed partial denture (RB-FPD) or a traditional fixed
partial denture (FPD)—infrequently prescribed.
However, a routine implant-based choice may be re-
garded as debatable in specific circumstances (eg,
1Assistant Professor, Department of Oral Implantology and Prosthetic
Dentistry, Academic Centre for Dentistry, VU University and University of
Amsterdam, Amsterdam, The Netherlands.
2Assistant Professor, Department of Oral Diagnostics, Department of
Dental Materials Science, Academic Centre for Dentistry, VU University
and University of Amsterdam, Amsterdam, The Netherlands.
3Professor in Adhesive Dentistry, Academic Centre for Dentistry, VU
University and University of Amsterdam, Amsterdam, The Netherlands.
4Professor, Head of the Department of Oral Implantology and Prosthetic
Dentistry, Academic Centre for Dentistry, VU University and University of
Amsterdam, Amsterdam, The Netherlands.
Correspondence to: Dr Ruud Kuijs, Department of Prosthodontics
VU University and University of Amsterdam, Gustav Mahlerlaan 3004,
1081 LA Amsterdam, The Netherlands. Email: R.Kuijs@acta.nl
©2016 by Quintessence Publishing Co Inc.
polypharmacy use in an aging population). Further
drawbacks of implant therapy include its inherent in-
vasive nature and its possible complexity and associ-
ated treatment expense.
The present authors’ collective clinical experience
suggests that the RB-FPD should be regarded as the
first prosthodontic treatment option to consider. It is
minimally invasive, which makes it especially benefi-
cial for medically compromised patients, and it is cer-
tainly not contraindicated when ongoing craniofacial
growth is a concern. It is also the best fit with a so-
called dynamic treatment concept that permits future
alternative treatment options.
It may be presumed that an RB-FPD should not be
a first treatment option since it is considered a tem-
porary solution with a limited lifespan. However, the
question then arises: How long should an RB-FPD’s
lifespan be if it is considered successful? The answer
is a compelling one: The success rate can be very high
if the indication and treatment are carried out care-
fully. A choice has to be made between a direct and
indirect technique, between cantilever-type and fixed-
fixed design, and of the material to use. Each type of
RB-FPD has specific advantages. The choice will de-
pend on factors such as interproximal space at the
connector area, anterior or posterior tooth replace-
ment, esthetics, and the patient’s wishes. Evaluating
all these factors demands thorough knowledge and
skills, qualities that should not be underestimated.
When a metal-based RB-FPD is prescribed for its
high stiffness and strength, preparation of grooves
and slots in the abutment teeth will significantly im-
prove the survival of the prosthesis.1 Metal requires
less volume than ceramic or composite to provide
sufficient strength and prevent fracture.1 It is there-
fore a better choice for the posterior region or in

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Resin-Bonded Fixed Partial Denture as First Treatment Consideration

Table 1   Classification of Diverse Clinical Situations Requiring Replacement With Resin-Bonded Fixed Prostheses6
Straightforward Advanced Complex
FPD type Indirect composite/Metal Direct composite
  No fiber/fiber No fiber Fiber
Location Lateral incisor Premolar Central incisor Molar Canine
Location Maxilla Mandible
Smile line No gingival tissue exposed Gingival tissue visible when smiling
Abutment teeth
Restoration Small restorations Large restorations Endodontic treatment
Approximal surface Large Small
Discoloration None Much
Crown length Large Small
Teeth positions Regular Rotated/extruded/intruded
Tooth shape Rectangular Triangular
General health Good Compromised
Parafunctional activity No Yes
Occlusion Class 1 Class 2 Deep bite
Interproximal space Large Small
Diastema width 1 tooth < 1 tooth > 1 tooth 2 teeth > 2 teeth
Additional veneers indicated No Yes
Patient’s expectations Low High
FPD = fixed partial denture.

Fig 1   Replacement of a lateral incisor, in this case a straightforward situation that meets almost all the proposed criteria.

situations where the interproximal connector area is
limited due to short clinical crowns or an unfavorably
limited vertical occlusal relationship. A resin compos-
ite RB-FPD, on the other hand, requires an adequate
volume of composite resin, especially at the connector
area.2 Tooth-colored restorations are preferable in es-
thetically visible locations, and fiber-reinforced resin
composite is the best-known tooth-colored material
combination applicable for RB-FPDs. It can be applied
directly in the mouth or made by a dental technician.
In RB-FPD design, abutment teeth should permit
optimal retention considerations. Adding more abut-
ment teeth will not improve the survival of the RB-
FPD.3 Adequate retention should not involve more
abutment teeth than necessary. This means that if a
large connector area is present, a cantilever RB-FPD
will be the design of choice.4
Every RB-FPD design requires specific dental
skills. Table 1 suggests guidelines for more straight-
forward and more complex treatments. This classifi-
cation is based on the Straightforward, Advanced, or
Complex (SAC) classification in implant dentistry.5 It
guides the choice of a best match between ease and
range of specific treatment needs and professional
skills (Figs 1 to 4).
Finally, it should be emphasized that besides
the RB-FPD and the implant, the conventional FPD
should also be considered as a treatment option, as
it is a proven concept for many situations involving a
missing tooth.

338 The International Journal of Prosthodontics

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 Kuijs et al

Fig 2   First premolar lost due to periodontal problems resulting in a straightforward situation. The use of the crown of the natural tooth as a pontic
makes the restoration less complex. The location is esthetically less demanding than the situation in Fig 1.

Fig 3   An advanced situation. The pontic is modeled intraorally, which makes the procedure more complex.

Fig 4   A complex situation due to the large space between the two abutment teeth, the modeling of two pontic teeth intraorally, and the use of
the direct technique.

 
Acknowledgments
The authors reported no conflicts of interest related to this study.  
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