Fixed Prosthodontics

(Treatment Planning for the

Replacement of Missing Teeth)

(Special Problems)

12 pages

Prof. Siham Sayes

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 Special Problems
Pier abutments

Rigid connectors (eg, solder joints) between pontics and retainers are the
preferred way of fabricating most fixed partial dentures
fixed partial denture with the pontic rigidly fixed to the retainers provides
desirable strength and stability to the prosthesis while minimizing the stresses
associated with the restoration.

However, a completely rigid restoration is not indicated for all situations

requiring a fixed prosthesis.

Pier Abutment is an intermediate abutment for a fixed partial denture. An

edentulous space can occur on both sides of a tooth.

In this frequently occurring situation, the maxillary first premolar and molar are missing,
leaving the second premolar as a pier abutment.

Rigid connector in the case of pier abutment, it is notrecommended. Because of:

o Physiologic tooth movement,

o arch position of the abutments,
o and a disparity in the retentive capacity of the retainers can make a rigid
five unit fixed partial denture a less-than-ideal treatment plan.

Studies in periodontometry have shown that the faciolingual movement

ranges from 56 to 108 um.

Teeth in different segments of the arch move in different directions. Because

of the curvature of the arch, the faciolingual movement of an anterior tooth
occurs at a considerable angle to the faciolingual movement of a molar.

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 108

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The amount offaciolingual movement (in um) for each tooth in the maxillary arch (based on
data by Rudd). The drection of movement, indicated by arrows, varies considerably from
the anterior to the posterior segment of the arch.

These movements of measurable magnitude and in divergent directions can

create stresses in a long-span prosthesis that will be transferred to the
abutments.

o Because of the distance through which movement occurs,

o the independent direction and magnitude of movements of the
abutment teeth,
o and the tendency of the prosthesis to flex, stress can be
concentrated around the abutment teeth as well as between
retainersand abutment preparations
t has been theorized that forces are transmitted to the terminal retainers as a
result of the middle abutment acting as a fulcrum, causing failure of the
weaker retainer.
The loosened casting will leak around the margin, and caries is likely to
become extensive before discovery.

The retentionon ananterior tooth is usually less than that of a posterior tooth
because of its generally smaller dimensions. Because there are limits to
increasing a retainer's capacity to withstand displacing forces, some means
must be used to neutralize the effects of those forces. The use of a nonrigid
connector has been recommended to reduce this hazard.
In spite of an apparently close fit, the movement in a nonrigid connector is
enough to prevent the transfer of stress from the segment being loaded to the
rest of the fixed partial denture.

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 of the fixed
A nonrigid connector on the middle abutment isolates force to the segment
to which it is applied.
partial denture
mechanical union of retainer and
The nonrigid connector is a broken-stress
connector.
pontic instead of the usual rigid

The most commonly used nonrigid design consists of a T-shaped key that is
retainer.
attached to the pontic and a dovetailkeyway placed within a
The location the stress-breaking device in the five-unit pier-abutment
of
restoration is important. It is usually placed on
the middle abutment because
abutments could result in the pontic
placement on either of the terminal
acting as a lever arm.

o The keyway of the connector should be placed within the normal distal
contours ofthe pier abutment,
o and the key should be placed on the mesialside of the distal pontic.
lean slightly in a mesial
The long axes of the posterior teeth usually
forces produce further movement
direction, and vertically applied occlusal
teeth tilt mesially when subjected
in this direction. Nearly 98% of posterior
to occlusal forces. If the keyway of
the connector is placed on the distal side
of the pier abutment, mesial movement seats the key into the keyway more
solidly.

Mesel
movomem

Sestng ection

middle abutment,
placed on the distal side of the retainer on a
If a nonrigid connector is
movement in a mesial direction will seat the key into the keyway.

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Placement of the keyway on the mesial side, however, causes the key to be
unseated during mesial movements. In time, this could produce a pathologic
mobility in the canine or failure of the canine retainer.

Mes
meee

Uheeating ctlon

If a nonrigid connector is placed on the mesial side of the middle abutment, mesially
directed movement will unseat the key.

Tilted molar abutments

A problem that occurs with some frequency is a mandibular second molar
abutment that has tilted mesially into the space formerly occupied by the first
molar. It is impossible to prepare the abutment teeth for a fixed partial
denture along the long axes of the respective teeth and achieve a common

path of insertion.

When a mandibular molar tilts mesially, there is a discrepancy between its long axis and
that of the premolar.

There is further complication if the third molar is present. It usually will have
drifted and tilted with the second molar. Because the path of insertion for the
fixed partial denture will be dictated by the smaller premolar abutment, it is
probable that the path of insertion will be nearly parallel to the former long
axis of the molar abutment before it tilted mesially. As a result, the mesial
surface of the tipped third molar will encroach upon the path of insertion of
the fixed partial denture, thereby preventing it from seating completely
 to the.fixed partial denture - -

This.fixed partial denture will not seat because the tooth distal
intrudes on the path of insertion (arrow).

be remedied by restoring or
If the encroachment is slight, the problem
can

recontouringthe mesialsurface ofthe third molar.

corrective m e a s u r e s are
called for. The
If the tilting is severe, more extensive
In
molar by orthodontic treatment.
treatment of choice is the uprighting of the and
tooth in a better position for preparation
addition to placing the abutment
molar also
occlusal loading, uprighting the
for distribution of forces under
of the root.
eliminate bony defects along the mesial surface
helps to

view.
Orthodontic appliance for uprighting a tilted molar: (a) occlusal view; (b) facial

or if it is possible to achieve only

a
If orthodontic correction is not possible,
denture can still be made. It has been
partial correction, a fixed partial abutments should converge by
suggested that the long axis of the prospective
no more than 25 to 30 degrees.
retainer on the distal
I. A proximal crown sometimes can be used as a
half crown that
abutment. This preparation design is simply a three-quarter
has been rotated 90 degrees so that the uncovered.This
distalsurface is
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 eariey
retainer tan be verd onty # the diataltrfare itetelf it untouehetd by
earies
or decalcifit otion and if there ka very lew ineidene e of priovimal
demonstrate an ability to
throughout the mouth The patient merst alko
keep the area evceptionaly tlea

a retainer on a
tilted molar abutment
Fixed partial denture using a proximal half crown as

a retainer on
the distal
can also be used as
A crown and coping
telescope made to
with heavy reduction is
abutment A full crown preparation
is made to fit the
follow the long of the tilted molar. An inner coping
axis
half crown that will serve as the
tooth preparation, and the proximal
This
denture is fitted over the coping.
retainer for the fixed partial
of the clinical crown while
restoration aliows for total coverage
the
between the paths of insertion of
compensating for the discrepancy
for this restoration is provided by
abutments The marginal adaptation
the coping

and coping as a retainer on a tilted molar

Fixed partial denture using a telescope crown

abutment

The nonrigid connector is another solution to the problem

of the tilted
.
fixed partial denture abutment. A preparation is done on the
full crown
molar, with its path of insertion parallel with the long axis of that tilted
 tooth. A box form is placed in the distal surface of the premolar
accommodate a keyway inthedistal of the premolar crown. It is tempting
to place the connector on the mesial aspect of the tipped molar, but this
could lead to even greater tipping of the tooth.

retainer compensates for the

A nonrigid connector on the distal aspect of the premolar
inclination of the tilted molar.

Canine-replacement fixed partial dentures

the canine
canines can be difficult because
Fixed partial dentures replacing abutments are the
The prospective
often lies outside theinterabutment axis.
tooth in the entire arch, and the first
lateral incisor, usually the weakest
tooth. A fixed partial denture replacing
a
premolar, the weakest posterior mandibular
to more stresses than that replacing
a
maxillary canine is subjected
transmitted outward (labially) on the maxillary arch,
canine because forces are
curve (its weakest point).
against the inside of the

canine is subjected to more damaging stresses

A fixed partial denture replacing a maxillary
canine because the forces are directed outward and the
than that replacing a mandibular
interabutment axis.
pontic lies farther outside the

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On the mandibular canine, the forces are directed inward (lingually), against
the outside of the curve (its strongest point).

A fixed partial denture replacing a mandibular canine has a more favorable prognosis than
that replacing a maxillary canine because the forces are directed inward and the pontic will
be closer to the interabutment axis.

considered a complex
Any fixed partial denture replacingacanine should be
fixedpartial denture.
No fixed partial denture replacing a canine should replace more than one

additional tooth.
An edentulous space created by the loss of a canine and any twocontiguous
teeth is best restored with a removable partial denture.
Cantilever fixed partial dentures

is that has an abutment or abutments at

A cantilever fixed partial denture one

the other end of the pontic remaining unattached.

one end only, with

This is a potentially destructive design with the lever arm

created by the
pontic, and it is frequently misused.

In the routine three-unit fixed partial denture, force that is applied to the

pontic is distributed equally to the abutment teeth.

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 interabutment axis line, less
If there is only one pontic and it is near the
the retainers than with a
leverage is applied to the abutment teeth and to
cantilever.
be
Prospective abutment teeth for cantilever fixed partial dentures should
favorable configuration,
evaluated with an eye toward lengthy roots with a

long clinical crowns, good crown-root ratios, and healthy periodontium.

dentures should replace onlyone tooth and

Generally, cantilever fixed partial
have at least two abutments.

A cantilever can be used for replacing

a maxillary lateral incisor.

occlusal contact on the pontic.

1. There should be no
abutment, it has a long root and good
2. The canine must be used
as an

bone support. a rest

on the mesial of
the pontic against
3. There should be a rest the distal of the
metallic restoration on
in an inlay or other
preparation and abutment.
rotation of the pontic
central incisor to prevent
it an undesirable
of a central incisor makes
4. The root configuration
cantilever abutment.

lateral incisor, using the canine as the

Cantilever fixed partial denture replacing a maxillary
abutment.

Acantilever pontic can also be used to replace a missing first premolar.

contact is limited to the distal

1. This scheme will work best if occlusal
fossa.
2. Full veneer retainers are required on both the second premolar and first
molar.
3. These teeth must exhibit excellent bone support.

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 used
replace a first premolar if full veneer retainers
are
A cantilever pontic can be used to
on the second premolar and first molar abutments.

when
Cantilever fixed partial dentures can also be used to replace molars
this type of fixed partial
there is no distal abutment present. Most commonly,
it is used to
denture is used to replace a first molar, although occasionally
replace a second molar to preventsupereruption ofopposingteeth.
as a
abutment tends to act
When the pontic is loaded occlusally, the adjacent
farthest retainer.
fulcrum, with a lifting tendency on the

the mesial abutment.

Forces on a full-size molar cantilever pontic place great stress on

as small
leverage effect, the pontic should be kept
as
1. To minimize the
molar.
possible, more nearly representing a premolar than a

2. There should be light occlusal contact.

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3. The pontic should possess maximum occlusogingival height to ensure a

rigid prosthesis.
retentive
4. A posterior cantilever pontic places maximum demands on the
reserved for those
capacity of the retainer. Its use, therefore, should be
on the
situations in which there is adequate clinical crown length
and
abutment teeth to permit preparations of maximum length
retention

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