Failures in Fixed Partial

Denture
 Classification of failures

By Bennard G.N Smith

1. Loss of retention
2. Loss of mechanical failure of crowns or bridge components
a) Porcelain
b) Failure of solder joints
c) Distortions
d) Occlusal wear
e) Lost facings
3. Changes in the abutment tooth
a) Periodontal disease
b) Problems with the pulp
c) Caries
d) Fracture of the prepared natural tooth or root
4. Design failures
a) Under prescribed FPD’s
b) Over prescribed FPD’s
5. Inadequate clinical or laboratory technique
a) Positive ledge
b) Negative ledge
c) Defect
d) Poor shape and color
6. Occlusal problems
 By John F Johnston
1. Discomfort
• Malocclusion or premature contact
• An oversized or poorly positioned mastication area, with retention of food
by pontics or retainers
• Torque produced from the Seating of the bridge or from occlusion
• An excess of pressure on the tissue
• Plus or minus contact area
• Over protected or under protected gingival and ridge tissue. ’
• Thermal shock
2. Looseness of FPD
• Deformation of the metal casting on the abutment
• Torque
• Technique 0f cementation
• Solubility of cement
• Caries
• Mobility of one or more abutments
• Lack of full occlusal coverage
• Insufficient retention in the abutment preparation
• Poor initial fit of the casting.
3. Recurrence of caries
• Over extension of margins
• Short castings
• Open margins
• Wear
• A retainer becoming loose
• Pontic form that fills the embrasure
• Poor oral hygiene
• Use of wrong type of retainer, which will promote caries susceptibility
• Permanent displacement of the gingiva due to temporary protection
4. Recession of supporting structure
• Length of the span
• Size of the occlusal table
• Embrasure form
• Few extensions of the cervical margins
• Impression technique can also stimulate recession of the gingiva.
4. Degeneration of Pulp
5. Fractures of bridge components
• A faulty solder joint
• Incorrect casting technique
• Overwork of the metal, due to length of the span or parts that are too small.
7. Loss of veneers
• Little retention .
• Badly designed metal protection
• Deformation of the protecting metal
• Malocclusion
• Improper fusing or technique
8. Loss of function
• They don’t function in occlusion
• They have no contact with opposing teeth
• They have permanent contact
• Over carved or under carved occlusal surface may impair efficiency
• Loss of opposing or approximating teeth
9. Loss of teeth tone or form
• Pontic design
• Position and size of the joints
• Embrasure form
• Over contouring and under contouring of retainers
• Oral hygiene practiced by the dentist
10. Failure to seat
• The abutment preparations may not be near parallel
• Soldering assembly may have been incorrect, or relationship of the
retainers may have been altered during soldering
 Types of bridge failure
1.Cementation failure
2.Mechanical failure
3.Gingival and periodontal breakdown
4.Caries
5.Necrosis of pulp
6.Biomechanical failure
7.Esthetics failure
 1. Cementation failure
• Broadly divided into
1. Cement failure
2. Retention failure
3. Occlusal problems
4. Distortion of FPD
1.Cement failure
• The primary function of the luting agent is to provide a seal
preventing marginal leakage and pulp irritation. The luting agent
should not be used to provide significant retentive and resistive
forces.
• failure can also occur because of a poor cementation technique. This
maybe due to the wrong choice of material, failure to observe the
manufacturer's mixing instructions, the use of old or contaminated
material, an inadequate powder/liquid ratio, or the insertion of the
prosthesis when the cement has started to set.
 ….contd.
• An inadequately cemented restoration may cause
1. An increased vertical dimension of occlusion
2. A loosening of the crown or FPD after a relatively short time
3. Leakage and decay under the abutment
4. The unsightly appearance of a metal margin where originally the
metal was concealed under the gingiva
5. Sensitivity to sweets or brushing due to exposure of the cervical end
of the tooth
• Causes of cement failure
1. Cement selection
2. Old cement
3. Prolonged mixing time
4. Thin mix
5. Cement setting prior to seating
6. Inadequate isolation
7. Incomplete removal of temporary cement
8. Thick cement space
9. Inclusion of cotton fibers
10.Insufficient pressure
2. RETENTION FAILURE
• For a restoration to accomplish its purpose, it must stay in place on the
tooth. No cements that are compatible with living tooth structure and the
biologic environment of the oral cavity possess adequate adhesive
properties to hold a restoration in place solely through adhesion. The
geometric configuration of the tooth preparation must place the cement in
compression to provide the necessary retention and resistance.
• CAUSES FOR RETENTION FAILURE
1. Excessive taper
2. Short clinical crowns
3. Misfit
4. Misalignment
3. OCCLUSAL PROBLEMS
• Following the placement of a dental restoration, a patient might report
discomfort ranging from a feeling of 'lameness' to ‘severe and constant pain'.
Sensitivity, in most cases, is due to pulp irritation from traumatic contact or
greater leverages. When the occlusion has been adjusted each type of
discomfort may be relieved almost instantly and should disappear shortly.
• Causes in occlusal problems
1. Immediate problems
• Marginal ridges at different levels
• Supra eruption of the opposing tooth
• Parafunctional habits
2. Delayed problems
• Wearing of occlusal surface
• Loss of occlusal contact
• Food lodgment due to plunger cusp )- Fracture. of facing due to defective occlusal
I

contact
4. DISTORTION OF FPD
• Due to loss of margin Integrity
• Causes:-
1. Bending of FPD
2. Incomplete casting
3. Incomplete casting
4. Bending of long span FPDs
5. Inadequate FPD design
 2. Mechanical failure
• Classification of mechanical failure
1. Retainer failure
2. Pontic failure
3. Connector failure

1. RETAINER FAILURE
1. Perforation
2. Marginal discrepancy
3. Facing failure
1. Fracture
2. Wearing
3. Discoloration
2. PONTIC FAILURE
• Factors affecting selection and failure of pontics
1. Pontic space
2. Residual ridge contour
3. Biological consideration
1. Ridge relation
2. Dental plaque
3. Gingival surface of pantie (Contact with mucosa)
1. Mucosal contact
2. Non mucosal contact
3. Pontic ridge relationship
4. Pontic material
5. Biocompatibility
6. Occlusal forces
7. Metal substructure
3. CONNECTOR FAILURE
• Causes for connector failure
1. Improper selection of connector
2. Thin metal at the connector
3. Incorrect selection of solder
4. Solder gap - narrow or wide
5. Porosity
6. Insufficient metal around
7. Defective occlusal contacts over thin connectors
 3. Gingival and periodontal breakdown
• Margins are one of the most important and weakest links in the
success of FPD restorations. One of the prime goals of restorative
therapy is to establish a physiologic periodontal health.
• A successful prosthesis depends on a healthy periodontal
environment and periodontal health depends on the continued
integrity of the prosthodontic restoration.
• All displacement techniques have the potential damage gingiva,
attachment apparatus a!1d bone, .especially if anatomic, forms are
weak or if disease is present.
• In healthy patients, properly used cord displacement or copper
band methods have proved to be atraumatic.
• The margin is one of the components of the cast restoration most
susceptible to failure, both biologically and mechanically.
• Most of the investigative proof shows that supra-gingival margins
are kinder to the gingiva than are subgingival margins. However,
practicality dictates that supra-gingival margins are not always
usable
• There are three locations in which to prepare crown margins:
• Supragingival
• At the crest of the gingiva
• Subgingival
• SUPRAGINGIVAL Vs SUBGINGIV AL MARGINS:
• Whenever possible, the margin of the preparation should be Supra-
gingival.
• Subgingival margins of cemented restorations have been identified as
a major factor in periodontal diseases, particularly where they
encroach on the epithelial attachment.
• Supragingival margins are easier to prepare accurately without
trauma, of the soft, tissues. They can usually also be situated, on
hard enamel, whereas subgingival margins are often on dentin or
cementum.
• SUPRA-GINGIVAL MARGINS
• ADVANTAGES:
• They can be easily finished
• They are more easily cleaned
• Impressions are more easily made, with less potential for soft tissue damage
• Restorations can be easily evaluated at recall appointments
• DISADVANTAGE:
• Aesthetically pot indicated for anterior region
• Metal can be seen
• Not indicated in short clinical crowns
• The proximal contacts extend to the gingival crest
• In case of root sensitivity
• SUBGINGIVAL MARGINS
• SPECIFIC DEMANDS FOR SUBGINGIVA L MARGINS:
• Aesthetic demands
• Caries removal
• To cover existing subgingival restorations
• To gain needed crown length
• To provide more favorable crown contour
• DISADVANTAGES:
• Difficult for preparation
• Gingival management should be perfect
• Prone for soft tissue trauma
• More prone for gingival and periodontal pathosis
• Difficult to maintain oral hygiene
• Metal margins can be seen thru the gingiva
• Soft tissue problems
• Causes:-
1. Over/ under contouring
2. Narrow embrasures
3. Over/ under extended crowns
4. Pressure of pontic over tissue
5. Loss of contact
6. Horizontal food impaction due to plunger cusp in the opposing arch
7. Marginal ridges at different level
8. Wide occlusal table
9. Trauma from occlusion
10.Acrylic facing in contact with the gingiva
11.Parafunctional habits
RESULTS OF IMPROPER CONTACT AREAS
1. Cause displacement of teeth bucally, lingually, mesially and distally.
2. Exert a lifting force on the tooth when placed too high occlusally.
3. Disturb the axial relation of the teeth, resulting in trauma.
4. Cause rotation of the teeth.
5. Cause injury to the investing structures by excessively opening or closing
the contact and interproximal embrasures.
6. Disturb the coordination of the inclined planes and cusps causing
deflective occlusal contacts.
7. Cause vertical or horizontal food impaction.
• OVER EXTENDED CROWN
• The over extended crown usually encroaches beyond the cut of the
preparation on the tooth and the excess beyond the margin of the
preparation is usually not in contact with the tooth surface.
• This overhang impinges the gingival tissue, irritates and often causes
edema and proliferation of the gingival tissue, destruction of the marginal
alveolar bone and ultimate loss of the tooth.
• The overextension of the crown is usually due to inaccurate technique
and/or the dentists desire to 'play safe' by making it long enough to cover
the preparation or to extend beneath the gingival margin.
• SHORT CROWN
• The short crown fails to cover the cut surface of the prepared tooth and often
does not extend below the gingival margin. This uncovered ground tooth surface
is often sensitive to sweets and to temperature changes and invites development
of caries and causes gingival irritation. Also, it is usually due to inadequate
technique and a willingness of the dentist to accept impressions that are
incomplete.
• CONTOUR
• The poorly contoured crown is one which may have an excess contour that
impinges on the gingival tissue and deflects food over and away from this tissue,
thereby depriving it of its normal stimulation; or it may be under contoured and
permit the impaction of food into the gingival crevice, thereby stripping the
gingival tissue away from the tooth. Either will cause irritation of the surrounding
tissue and may lead to the loss of the tooth.
 4. Caries
• Causes:-
1. Iatrogenic
1. Failure to identify caries
2. Incomplete removal of caries
3. Rough abutment finishing margins
4. Subgingival marginal placement in inaccessible areas or regions
5. Burning of root dentin or cementum in electro surgical technique (leads to damage or
rough surface and causes plaque retention)
6. Overhanging margins
7. Rough margins of crowns or bridges
8. Over contouring of the cervical thirds of crowns or bridges prevents the physiologic
cleaning by tongue or muscles
9. Marginal discrepancy
10.Thick cement space in margins leads to cement dissolution
11.Narrow embrasures (inaccessibility to maintain hygiene)
12.Wide connector
13.Failure to motivate or educate the patient about oral hygiene
• Patient role:-
• Systemic factors
• Xerostomia
• Due to radiation therapy
• Drug induced
• Endocrine disorders
• Epilepsy ( difficult to maintain the oral hygiene)
• Rheumatoid arthritis
• Local factors
• Improper brushing and flossing
• Dietary habits
• Failure to understand importance of oral hygiene
 5. Pulp degeneration
• A pulp may degenerate because of too rapid preparation of the
tooth or because of improper cooling during preparation. Teeth
unprotected during the construction of a FPD are exposed to saliva
and the resulting irritation

• Pulp reactions to various procedures

• Each step in full crown preparation presents hazards, which may injure the
pulp. The result may be pulpitis or even necrosis. Among the many
essential procedures that may cause pulp injury are tooth preparation,
impression making, temporization and cementation. In general, heat
desiccation and/ or chemical injury cause the insult.
 6. Biomechanical failure
• Every restoration must be able to withstand the constant occlusal forces to
which it is subjected. This is of particular significance when designing and
fabricating an FPD, since the forces that would normally be absorbed by the
missing tooth are transmitted through the pontic, connectors and retainers to
the abutment teeth.
• The abutment teeth are therefore called upon to withstand forces directly to the
missing teeth in addition to those usually applied to them.
• In addition to increased load placed on the periodontal ligament by a long span
FPD, longer spans are less rigid. Bending or deflection varies directly with the
cube of the length and inversely with the cube of the occluso-gingival height of
the pontic. Compared with the FPD having a single tooth span, a two-toothed
pontic span will bend eight times as much, and a three-toothed pontic will bend
27 times as much.
• Owing to the fact that forces are being applied though the pontics to the
abutment teeth, the forces on the castings serving as retainers are
different in magnitude and direction from those applied to a single
restoration. The dislodging forces on an FPD retainer tend to act in a
mesio-distal direction as opposed to the common bucco-lingual direction
of forces on single restorations.
• Preparations should be modified accordingly to produce greater resistance
and structural durability e.g. grooves on buccal and lingual surfaces.
Double abutments are sometimes used as a means of overcoming
problems created by unfavorable crown-root ratios and long spans. A
secondary abutment must have at least as much root area and as favorable
a crown-root ratio as the primary abutment it is intended to bolster.
 6. Esthetics failure
• REASONS FOR ESTHETIC FAILURE
1.Failure to identify patient expectations regarding esthetics
2.Improper shade selection
3.Excessive metal thickness at incisal and cervical regions
4.Thick opaque layer application
5.Surface blistering ( chalky appearance)
6.Over glazing or too smooth a surface
7.Metal exposure in connector, cervical and incisal regions
8. Dark space in cervical third due to improper pontic selection
(anteriors)
9. Failure to produce incisal and proximal translucency
10.Improper contouring
11. Fai1ure to harmonize contra lateral tooth morphology
• Contour
• Color
• Position
• Angulation
12. Discoloration of facing