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The current status of the design of resin-bonded fixed partial dentures,

splints and overcastings

Article in Japanese Dental Science Review · January 2013

DOI: 10.1016/j.jdsr.2013.10.003

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Review Article

The current status of the design of

resin-bonded fixed partial dentures,
splints and overcastings
Hiroshi Shimizu *, Tomohiro Kawaguchi, Yutaka Takahashi

Division of Removable Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College,

Fukuoka, Japan

Received 24 May 2013; received in revised form 18 October 2013; accepted 28 October 2013

KEYWORDS Summary This review article describes the current status of resin-bonded fixed partial
Design; denture, splint and overcasting design. Several such designs have been introduced through
Resin-bonded fixed the years, but there is no typical standard yet for the design of anterior resin-bonded prostheses.
partial denture; On the other hand, the design of posterior resin-bonded prostheses has generally been a standard
Resin-bonded splint; D-shaped structure. To splint abutment teeth, including pathological mobile teeth, the applica-
Resin-bonded tion of resin-bonded retainers with additional retentive structures is recommended. Although a
overcasting; conventional design for resin-bonded overcastings has not been established yet, it is usually easy
D-shaped design to add mechanical structures. The problem in clinical practice is the esthetics of the retainers,
although the key to solving this problem may be to apply tooth-colored material.
# 2013 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
2. Design of anterior resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
3. Design of posterior resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
4. Design of resin-bonded overcastings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
5. Future outlook for the design of resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

* Corresponding author at: Division of Removable Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, 2-15-1, Tamura,
Sawara-ku, Fukuoka 814-0193, Japan. Tel.: +81 92 801 0411; fax: +81 92 801 0513.
E-mail address: simizuh1@college.fdcnet.ac.jp (H. Shimizu).

1882-7616/$ — see front matter # 2013 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jdsr.2013.10.003

Please cite this article in press as: Shimizu H, et al. The current status of the design of resin-bonded fixed partial dentures, splints and
overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
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JDSR-126; No. of Pages 6

2 H. Shimizu et al.

1. Introduction

In 1973, Rochette [1] reported on a peculiar splinting system

using composite resin as a cementing agent to attach perfo-
rated cast metal retainers to the acid-etched enamel of
periodontally compromised lower anterior teeth. This system
was conceived as a temporary procedure involving no tooth
reduction. Livaditis et al. [2] and Thompson et al. [3,4]
introduced the so-called Maryland Bridge technique using
electrolytically etched nonprecious Ni-Cr alloys. In this
method, the tooth preparation consisted of a small amount
of reduction including proximal extensions as a definitive
procedure. In 1978, 4-methacryloxyethyl trimellite acid Figure 1 Occlusal view of the early completed anterior Mary-
anhydride (4-META) was synthesized [5] and used as a reac- land Bridge.
tive functional monomer for adhesives to enamel, dentin,
dental alloy and ceramic. The history of the clinical applica-
tion of resin-bonded fixed partial dentures (RBFPDs) thus
started in the true sense of the word. The creation of
functional monomers for noble metal alloys containing sulfur
(VBATDT [6,7], MTU-6 [8] and MDDT [9]) represents excellent
progress in resin-bonded prosthetic practice. It should be
pointed out that an oxidation surface treatment for metals is
no longer required in this new adhesive system. Using func-
tional monomers including VBATDT, MTU-6 or MDDT, gold alloy
and Ag—Pd—Cu—Au alloy adhere directly to the resin materi-
als. The procedure is easy to perform, and technique errors
are less likely to occur in the clinic. Thereafter, a new era in
this field began with the use of noble metal alloys including
Ag—Pd—Cu—Au alloy, and the design of resin-bonded pros- Figure 2 Definitive cast shows preparations with grooves and
theses has been re-evaluated. pinholes in central and lateral incisors.
Thus in recent years, regardless of whether the location is
posterior or anterior, RBFPDs, as well as oral implants, have
been accepted as an alternative to conventional fixed partial
dentures when intact abutments are present and minimal
intervention is desired [10]. It seems that the RBFPD designs
with tooth reductions look similar to conservative partial
veneer abutment preparations. The present review article
focuses on the current status and future outlook for the
design of RBFPDs, as well as for splints and overcastings.

2. Design of anterior resin-bonded

prostheses

The application of the splinting system reported by Rochette
[1] has been limited to the mandibular anterior region
because it was conceived as a temporary procedure with
no tooth reduction. Howe et al. [11] tried to use perforated
retainers for the replacement of missing anterior teeth with-
out tooth reduction by selecting situations with open bites or
minimal occlusal function on the restoration. However, the
retainers frequently fractured due to insufficient strength, so
a high level of skill at the cementing procedure was needed.
The Maryland Bridge was the earliest representative of a non-
perforated retainer design; a base metal alloy retainer of the
RBFPD covered most of the lingual and proximal areas of the
anterior abutments with a small amount of tooth reduction
[2] (Fig. 1). Restoration has demonstrated the supragingival
margins that are a common feature of resin-bonded pros-
theses. Even if the abutment tooth is intact, sufficient
occlusal clearance must be provided for the retainers of
maxillary anterior RBFPDs. Furthermore, it is generally
Figure 3 Intaglio view of the anterior resin-bonded fixed
partial denture (RBFPD) with retentive pin.
believed nowadays that the tooth preparation design for
anterior RBFPDs should include grooves [12] or a pinhole
[13—16] as additional retentive structures (Figs. 2—4). A
methodical preparation design for anterior abutments
intended to preserve the patient’s innate occlusal guidance
[17] (Figs. 5 and 6). This design extends the reduction to part
of the occlusal wear facets, making it possible to preserve the
patient’s innate occlusal function and hold the retainer
firmly. Consequently, the functional force from the antag-
onistic teeth should load the retainer and enamel facets
equally. Such force should correctly press the retainers to
the abutments and should not debond the retainer from the
bonded enamel. One of the remaining problems of maxillary
anterior RBFPDs is the difficulty involved in thickening the

Please cite this article in press as: Shimizu H, et al. The current status of the design of resin-bonded fixed partial dentures, splints and
overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
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JDSR-126; No. of Pages 6
Design of resin-bonded fixed partial dentures, splints and overcastings
Figure 4 Completed RBFPD after placement.
Figure 5 Definitive cast shows partial preparation in canine as
well as conventional full coverage preparation in central incisor.
Figure 6 Completed RBFPD blends well in the patient’s oral
cavity.
retainers due to anterior-guided occlusion. However, no
design has ever resolved this problem.
Splinting with partial veneered restorations is considered
to be useful as are full coverage restorations for stabilizing
the dentition with pathological mobility mainly caused by
periodontal diseases. However, a long-term follow-up [18]
indicated that mobility of the abutment teeth is one of the
decisive prognostic factors for the success of RBFPDs.
Furthermore, it was reported that a RBFPD without any
retentive preparation form failed at a significantly higher
rate [19]. Therefore the application of resin-bonded retai-
ners with additional retentive structures, such as a pinhole
and grooves in the anterior region, a method combining
enamel etching and the use of unfilled resin adhesive, was
recommended [20].
Please cite this article in press as: Shimizu H, et al. The current status of the design of resin-bonded fixed partial dentures, splints and
overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
3
Figure 7 Definitive cast shows preparations of the typical
posterior early Maryland Bridge in premolar and molar.
3. Design of posterior resin-bonded
prostheses
The early design of the posterior Maryland Bridge included
axial coverage and an occlusal rest, as shown in Figs. 7 and 8.
There was little proximal and lingual enamel reduction.
Posterior RBFPDs appeared to require a 180-degree-plus
circumferential preparation for predictable success, based
on the results of the first 5 years of a 10-year longitudinal
study [21]. Then it was realized that the preparation design
should include mechanical retention such as grooves for
resistance [22—24]. The L-shaped retainer covers one—half
of the lingual cusp with a groove at the far side of the buccal
line angle as well as a groove at the opposite far side of the
lingual line angle in order to hold the abutment teeth firmly.
Recently, a D-shaped retainer has become popular. Chow
et al. [25] presented an approach using a groove, plate,
and strut, which involved minimal preparation of the poster-
ior abutment to receive a RBFPD using a base metal alloy.
Botelho et al. [26] advised that the major retainer should
have a wrap-around configuration on at least three surfaces
of the abutment or have strategically placed opposing axial
grooves or slots for long-span prostheses that replace two or
more missing teeth. Another report [27] described a meth-
odical preparation for posterior partial veneered restorations
that provides sound posterior occlusal function and isolates
the occlusal contact area in the enamel to maintain the
vertical dimension of occlusion. It is especially effective
Figure 8 Lingual view of the completed posterior early Mary-
land Bridge.
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JDSR-126; No. of Pages 6
4 H. Shimizu et al.
Figure 9 Definitive cast shows D-shaped preparation in second
premolar and enamel island preparation in second molar.
Figure 10 Buccal view of the completed posterior RBFPD.
when a prosthesis has not been seated very long to replace
the missing teeth, and the intact mesial and distal teeth
incline toward the missing space (Figs. 9 and 10).
4. Design of resin-bonded overcastings
The overcasting technique was originally a technique designed
to avoid removal of restorations, such as fractured metal
ceramic fixed partial dentures [28—30] or adjacent FPDs
[31]. The technique remarkably developed through the use
of adhesive resin cement with metal conditioners [32,33]. An
overcasting restoration may provide faster treatment, fewer
appointments, less discomfort, simpler laboratory proce-
dures, and lower cost compared to replacing the restoration.
Figure 11 Preparations with two retentive pinholes for an
overcasting.
Please cite this article in press as: Shimizu H, et al. The current status of the design of resin-bonded fixed partial dentures, splints and
overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
Figure 12 Intaglio view of the overcasting with two retentive
pins.
Figure 13 Completed overcasting blends well in the patient’s
oral cavity.
Fig. 11 shows a preparation with two retentive pinholes
for an overcasting in response to an esthetic request from
the patient. Although the typical design of resin-bonded
overcastings has not yet been established, it is generally
easy to add mechanical structures such as grooves and
pinholes in overcastings compared to intact teeth. In this
situation, the overcasting was cast with type III gold alloy
with highly filled composite (Fig. 12). The facial surfaces of
the metal premolar restorations were replaced with an
overcasting with indirect composite using an adhesive
luting agent (Super-Bond C&B Ivory, Sun Medical Co.,
Ltd., Moriyama, Japan) which resulted in a good appear-
ance (Fig. 13).
5. Future outlook for the design of resin-
bonded prostheses
Evaluation of the current status indicates that the design of
posterior resin-bonded prostheses has almost become D-
shaped. This design is almost complete with no clinically
significant problems and will be used for the foreseeable
future. On the other hand, there is no typical standard yet
for the design of anterior resin-bonded prostheses. The avail-
able surfaces to be bonded are limited from the esthetic
viewpoint to the lingual surface and a portion of the proximal
surface in the anterior region. Hence, it is difficult to use a
wrap-around design in this region. Consequently, there is
a limitation to adding mechanical retention obtained by design
although the improvement of the bond strength of the
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JDSR-126; No. of Pages 6
Design of resin-bonded fixed partial dentures, splints and overcastings
Figure 14 Anterior RBFPD using zirconium oxide on the defini-
tive cast.
Figure 15 Completed anterior RBFPD using zirconium oxide
blends well in the patient’s oral cavity.
adhesive resin material is definitely needed, particularly in
this region.
One practical clinical problem is the esthetics, a problem
that will not resolve itself even if a D-shaped design is applied
as long as a metal alloy is used in the retainer. The key to solving
this problem may be to use tooth-colored material such as
Zirconium oxide [34—36] and fiber-reinforced composite [37—
41] as the framework of the resin-bonded prosthesis (Figs. 14
and 15). There is a basic problem because the toughness of
these materials is lower than that of dental alloys. It was
reported that in zirconia restorations, the inlay and buccal
retainers have a failure load equivalent to that of a full crown
[35]. Especially with zirconia, the retainer design also depends
on the performance of the CAD/CAM system. On the other
hand, in their review paper, van Heumen et al. stated that it
was not possible to build a reliable regression model indicating
the risk factors in fiber-reinforced composite-RBFPDs [38].
Therefore, the fundamental retainer design of resin-bonded
prostheses should be established by using materials that are
different from the metal retainer system.
Conflict of interest statement
The authors declare no conflicts of interest. The authors alone
are responsible for the content and writing of the article.
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overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
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Please cite this article in press as: Shimizu H, et al. The current status of the design of resin-bonded fixed partial dentures, splints and
overcastings. Japanese Dental Science Review (2013), http://dx.doi.org/10.1016/j.jdsr.2013.10.003
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