FAILURES IN FIXED

PROSTHODNTICS

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Objectives of fixed prosthodontic
treatment
Preservation or improvement of related hard and
soft tissue structures.
Preservation or improvement of oral functions.
Improvement or restoration of esthetics.
Ensuring restoration retention, resistance, and
stability.
Providing restorations with mechanical or
structural integrity.
Preserving or improving patient comfort
Designing restorations for maximum longevity.

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CLINICAL IMPLICATIONS
Thus from the studies,one might expect
one third of fixed partial dentures to require
replacement by 15 years.

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A complication has been defined as “a
secondary disease or condition developing
in the course of a primary disease or
condition.”

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Complications ….

Indicate
Reflect
Clinical or Substandardcare
failure

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Classification of Failures

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Types of Failure
Biological
 Caries  Pontic failure
 Pulpal degeneration  Connector failure
 Periodontal breakdown  Occlusal wear
 Occlusal problems
 Tooth perforation •Esthetic failures

Mechanical
 Cementation failure
 Loss of retention
 Tooth fracture
 Retainer failure
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Types of Failures : Biological
1.Caries
One of the most common causes of
failure
“The greatest percentage of crowns (25%)
was removed because of caries and its
complications.”
Radiographs are useful – interproximal
lesions

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 Failure to

Iat Pa
●
●

identify ●
●Systemi
caries c:
●Incomplete
●

Xerosto

ro
removal of

tie
caries mia,
●Rough
epilepsy
●

abutment
●Local :

ge
●
margins
imprope

nt’
●Overhangin
●

g margins
●Marginal
●
r oral
hygiene
nic
discrepanc
y practice

s
●Subgingiva
, failure
●

lly placed

ca
margins to
●Narrow
●
understa

rol
embrasures
●Failure to
nd the

us
●

motivate / importa
educate the nce of

e
patient
about oral
good
hygiene
maintenanc
e
es oral
hygiene
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Usually perceived by the patient as
Pain or sensitivity due to hot, cold or
sweet foods and liquids
Bad taste
Bad breath
Loose restoration
Fractured teeth
Discolored teeth

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Cause should be investigated and proper
preventive measure applied
◦ Meticulous oral hygiene procedures for
patients with high caries index
◦ Other preventive measures
 Fluoride dentifrices
 Fluoride mouth rinses
 Professional fluoride application

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2. Pulp Degeneration
 Supporting structures or root length
maybe lost owing to periapical
involvement brought about by:
◦ Method of tooth preparation
◦ Irritation due to temporary coverage
◦ Lack of provisionalization
◦ Malocclusion

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 Post insertion pulpal sensitivity on
abutment teeth that doesn’t subside with
time
 Intense pain
 Periapical abnormality
Indicate a need for endodontic intervention

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3. Periodontal breakdown
One of the prime goal of restorative
therapy is to establish a physiologic
periodontal health
Margins of the prosthesis are one of the
most important and yet the weakest links
in the success

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Supragingival margins

Advantages: easy to Disadvantage: unaesthetic

in anterior region, not
finish, clean, make
indicated in short clinical
impressions and crowns, proximal contacts
evaluate at recalls extend to gingival crest

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Periodontal disease can produce extensive
bone loss loss of abutment & prosthesis
Plaque formation is the primary cause for
initiation of periodontal breakdown

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09/27/2021 18
If detected early,
Interfering

contacts
adjustmentscan
centric/
interferences can be
eccentric occlusal
eliminated by occlusal
cause
– no permanent
excessive tooth mobility
4. Occlusal problems
damage

Trau
matic
occlu
sion
on
teeth
previ
ously
weak
ened
by
perio
donta
l
disea
se/
long
term
prese
nce
of
occlu
sal
interf
erenc
es in
teeth
with
norm
al
bone
supp
ort
can
lead
to
MO
BILI
TY

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5. Tooth perforation
Pinholes / pins used in conjunction with pin retained
restorations maybe improperly located and may
perforate the tooth laterally

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Types of Failure: Mechanical
1.Cementation Failures
May be partial/ complete
Is normally the result of the retainers, which
are inadequate for the FPD in question
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

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 If a restoration/prosthesis gets
displaced, it is more often due
to an unretentive tooth
preparation or poor fit rather
than the choice of luting agents

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Besides an inadequate retainer, failure can also
occur because of a poor cementation technique
Tight
Tight
fit
fit of
of aa
crown
crown

Certain
thickness of
cement
remains
interposed
between
tooth and
crown –
improper
seating
Resista
Resista
nce
nce to
to
flow
flow of
of
cement
cement

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 Cement Old Prolonged
selection cement mixing time

Thin or Cement setting Inadequate

thick mix prior to seating isolation
Incomplete
removal of
Thick cement Inclusion of
temporary cement space cotton fibers

Insufficien
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2.Loss of Retention
For a restoration to accomplish its
purpose, it must stay in place on the tooth.
No cements that are compatible tooth
structure and biologic environment of the
oral cavity possess adequate adhesive
properties to hold a restoration solely
through adhesion

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The geometric configuration of the
tooth preparation must place the
cement in compression to provide
the necessary retention and
resistance

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Causes for loss of retention
◦ Excessive taper
◦ Short clinical crowns
◦ Mis-fit

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3. Tooth fracture
Gold foil, amalgam or resin can be used to restore
Minor fracture
●

the area to provide additional years of service

Large coronal Around partial coverage – impossible to restore tooth

●

Full coverage restorations can be made

fractures
●

●
Endodontic treatment
Pulp exposure ●
Post and coreJohnston’s Modern Practice in Fixed
Prosthodontics. 4th edition
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4. Retainer Failure
Perforation
Marginal discrepancy
Facing failure
◦ Fracture
◦ Wearing away
◦ Discoloration

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Perforation
◦ Causes of perforation:
 Insufficient occlusal reduction
 Insufficient occlusal material
 High points in opposing cusps (plunger cusps)
 Premature contacts
 Parafunctional habits

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Marginal discrepancy
◦ Junction of cemented restoration and the tooth
is always a potential site for recurrent caries
because of
 dissolution of the luting agent
 Inherent roughness
◦ Short margins
◦ Overextended margins

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Facing Failure
◦ Degradation of the facing is a common result
after exposure to the oral environment
◦ Materials used for veneering
 Resins
 Porcelains
◦ Types of veneer failures
 Fracture
 Wearing off of the facing
 Discoloration

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Causes for discoloration
◦ Absorption of oral fluids
◦ Absorption of artificial food coloring agents
through micro cracks in metal-facing interface
◦ Tarnish of underlying metal and facing
◦ Micro cracks due to malocclusion

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5. Pontic Failure
PONTIC

Esthetic
Principles –
satisfactory
appearance

Mechanical Biologic considerations

–facilitate plaque
principles - control, adjust to
strength and existing
existing occlusal
occlusal
longevity conditions

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6. Connector Failure
A connector may fracture under occlusal
forces
Failures of both cast and soldered
connections have been observed
Generally caused by internal porosity
which weakens the metal

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7. Occlusal Wear

Extreme wear on occlusal surface of crown

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Types of Failures: Esthetic
From an esthetic standpoint, there is no
substitute for healthy enamel

“Only God can make teeth”

- Joyce Kilmer

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causes
◦ Improper shade selection
◦ Excessive metal thickness at incisal and
cervical regions
◦ Thick opaque layer application
◦ Surface blistering (chalky appearance)

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◦ Metal exposure at connector, cervical and incisal
regions
◦ Dark space in cervical third due to improper pontic
selection (anteriors)
◦ Failure to produce incisal translucency
◦ Improper contouring
◦ Failure to harmonize contralateral tooth morphology
 Contour
 Color
 Position
 Angulation
◦ Discoloration of the facing
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Removal and Repairs

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Removing crowns

Gold crowns
◦ Cumine or Mitchelle’s trimmer
◦ Slide hammer type of remover
Posts and cores
PJCs
◦ Should be cut off
Metal Ceramic crowns
◦ Maybe removed intact with an instrument but
preferably should be sectioned
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Other commercially available crown
removal instruments

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Repairs by restoring in situ : occlusal
repairs
For Metal retainers – Amalgam
gold inlay
cohesive gold
For porcelain/ Metal Ceramic - composite

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 Although repairs are justified to extend
the life of an established crown or bridge,
they should never be used to adapt the
margins of poorly fitting bridges on
restoration

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In some cases, raising a full gingival flap
may be justified
Retainer margins can be adjusted and
restored under conditions of optimum
access and visibility
Any necessary periodontal or endodontic
treatment can be carried out at that same
time

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Repairs by restoring in-situ : repair of
porcelain
The lateral incisor facing
has chipped. The bridge is
more than 10 years old

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Stumbling blocks ?????

Stepping stones !!!!!!!

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