Case Report

Spring Cantilever: When and Why A Clinical Report

H S Kiran Kumar1, Sudhakara Bhat2, Sanjay Gouda Patil3, Sankar Madhavan4, Rahul Kulkarni5
Assistant Professor, Department of Prosthodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India, 2Professor and Head,
Department of Prosthodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India, 3Professor, Department of Prosthodontics,
Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India, 4Assistant Professor, Department of Prosthodontics, Sree Anjaneya Institute
of Dental Sciences, Modakkallur, Atholi, Kozhikode, Kerala, India, 5Post-graduate, Department of Prosthodontics, Sri Hasanamba Dental College and
Hospital, Hassan, Karnataka, India
1

A xed partial denture is routinely done for the replacement of the missing natural teeth. In the case of anterior missing teeth, conventional
cantilever type of xed partial denture is more conservative depending upon the case selection. Replacements of anterior teeth are challenging
when there is a generalized spacing between the maxillary anterior teeth. Shape and size of the pontic, which replaces the missing teeth has
to be in proportion with natural anterior teeth (golden proportion). In such cases, to achieve acceptable esthetics there may be a need to
involve more number of teeth by regular xed partial denture. Spring cantilever is an ideal solution in these situations. The present article
covers the case selection, advantages and disadvantages of spring cantilever type of xed partial denture.

Keywords: Partial denture, Pontic, Teeth

INTRODUCTION
With the advance in material science and bonding
technologies, restoration of missing anterior teeth can be
dealt with implants and conventional porcelain-fusedto-metal and resin-bonded fixed partial dentures.1,2 In
cases where edentulous space is excessive, and there
are surgical limitations, then a variant of fixed partial
denture the cantilever principle can be considered. 3
Cantilever fixed dental prosthesis, also known at various
times as the flying pontic, direct extension bridge, a free
end, swing-on or throw-off bridge.4 It is the type of fixed
partial denture in which the pontic is cantilevered, i.e., is
retained and supported only on one end by one or more
abutment.5

surgery for implant placement and wanted an immediate

fixed alternative for the right lateral incisor.
Instead of conventional fixed partial denture, to avoid
unnecessary involvement of sound adjacent tooth, and
posterior tooth needs crowning as well, a bar type of spring
cantilever bridge was planned to cover the edentulous space.
Thus, second premolar was decided as the abutment support
due to caries involvement.

PROCEDURE

CASE REPORT

Restoration and tooth preparation done in relation to the

right second premolar, with slight sub gingival finish line.
Retraction procedures were carried out, a polyvinyl siloxane
impression was made using the puy reline technique in a
rim-lock impression tray and cast was poured.

The case we present here is about a 40-year-old female

patient reported to the Department of Prosthodontics,
with a missing right maxillary lateral incisor (Figure 1). On
intraoral examination, the anterior edentulous space with
missing lateral incisor had increased mesio-distal width,
caries involving right second premolar and compromised
crown root ratio of sound adjacent teeth (Figure 2).

Keeping in mind, that the palatal bar connector should be

long, thin, and resilient, it should extend from the posterior
region, closely adapting to the palatal surface so that it is
partly supported by soft tissue.6,7 The wax paern for the
connector was fabricated using 0.8 mm 4 mm casting strip
wax, extending from second premolar towards edentulous
space (Figure 3).

A single tooth implant and removable partial denture was

a viable alternative. However, the implant would entail
surgery and a more protracted treatment. However, the
patient was neither willing for removable prosthesis nor

The rest of the laboratory procedures were common with

that of conventional metal-ceramic fixed partial denture
construction. Metal try-in was performed to verify the
extension, adaptation, fit of the casting (Figure 4). Ceramic

Corresponding Author:
Dr. H S Kiran Kumar, Department of Prosthodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India.
Phone: +91-9986047747. E-mail: dr.kiranhs@gmail.com

IJSS Case Reports & Reviews | September 2014 | Vol 1 | Issue 4

Kumar, et al.: Spring Cantilever

build up was completed, and the bridge was cemented

(Figure 5).

A cantilever beam by definition (Tylman, 1970), is a beam

that is supported by only one fixed support at one of its ends.
The cantilever principle has been applied in two-ways, in the
development of the spring cantilever bridge, in which the
pontic is supported by a bar aached to a remotely situated
retainer, and in the direct cantilever bridge, in which the
pontic is aached to an adjacent retainer.4,5

absorbed by the supporting palatal mucoperiosteum and

completely dissipitated before they reach the abutment
tooth.8 The spacing between the teeth can be maintained or
even altered based on the patients preference. However in
adhesive dentistry, this same design can be used except that
the fiing surfaces of the cast retainers have to be etched, and
resin cemented.9,10 According to recent literature two fixedfixed and two cantilever resin-retained palatal bar connector
bridges have been reported, but the palatal bar connectors
were short and the pontics were rigidly connected to their
retainers.11

One of the designs in spring cantilever bridge is the pontic

that is connected to its retainer by a relatively long flexible
palatal connector bar. Thus resembling a bridge that is fixed
only on one end, hence the name spring cantilever bridge.
As it is essentially a tissue-supported but tooth-retained
abutment, the forces of mastication acting on the pontic are

The popularity of spring cantilever fixed partial denture

began from Essig in 1897 and various modifications
(Thompson in 1947, Kantorowicz in 1957, Heigeiway and
Williams in 1962, Lemmer in 1963, Roussel in 1906 and
Johnstone in 1971) have been carried out ever since.12-14

Figure 1: Pre-treatment

Figure 3: Wax pattern

Figure 2: Pre-treatment close-up view

Figure 4: Metal try-in

DISCUSSION

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Kumar, et al.: Spring Cantilever

Table 1: Essential factors of a cantilever bridge

Good periodontal attachment
Good alveolar support
Favorable root length, shape and crown length
Favorable arch-to-arch relationship
Favorable tooth-to-tooth relationship

Figure 5: Post-treatment

Myers (1969), discuss the dangers of abutment rotation,

points out that it is necessary to consider such facts as
crown-root ratio, the amount of periodontal support and
the relation of the maxillary and mandibular incisors during
incision.15 Nally (1962) also draws aention to the way in
which anterior bridges are subject to palato-vestibular thrust
which tends to result in rotation about their main axes,
but makes it clear that the physiology of the jaw closing
movement and the type of occlusion must be taken into
consideration. Some situations are clearly less favorable
than others.16
Schweier17 and Ewing18 have wrien in a limited manner
on the cantilever principle and have shed some light on such
fixed restorations. Ewing found, in many instances wherein
the cantilever principle was employed in keeping within
the patients biologic limitations that such restorations
gave prolonged periods of service and did not cause tissue
destruction (Table 1).
As a general principle, conventional fixed bridgework,
supported by abutments at both ends, is to be preferred
if tooth structure, alignment and periodontal support
permit an aesthetic and functional result. However, there
are certain situations in which the fixed bridge will not
meet these requirements and where a partial denture as an
alternative could not be tolerated, or would be precluded
because of potential damage to periodontal tissues, or
simply on the grounds that a denture would prove socially
unacceptable19,20 (Tables 2 and 3).
Maintenance of health and comfort, serviceability and
longevity of the prosthesis, restoration of aesthetics and
function has been the main concerns in fixed prosthesis.
Schwar in 1970 had conducted a survey on life span and

IJSS Case Reports & Reviews | September 2014 | Vol 1 | Issue 4

serviceability of fixed partial denture and reported that

spring cantilever bridge have longer lifespan 3-4 times that
of other fixed partial denture.21 Walton in 1986 reported
an even lower mean life span in conventional fixed partial
denture. Caries of the abutment tooth accounted for
most of the failures, other being porcelain fracture, uncemented restorations, poor aesthetics, defective margins,
fractured root/tooth, periodontal diseases/mobility,
periapical involvement and fractured connectors.22 Lui
in 2008 reported that when a spring bridge is judiciously
designed it is able to satisfy the demands of the patient
to preserve their personal feature of spacing between the
teeth.23
Though spring cantilever bridge having a permanent long
flexible palatal bar is cumbersome to the patient as well
as the prosthodontist, but when cautiously fabricated and
aptly maintained by the patient, it can provide many years
of continued service in function and aesthetics.

SUMMARY
Drifting of teeth into the edentulous area may reduce the
available pontic space; whereas a diastema existing before
extraction may result in excessive mesio-distal width to the
ponticspace. In such situations, the simplest approach would
be to maintain the existing diastema by spring cantilever fixed
partial denture. The design and application of spring cantilever
bridgework are evaluated in relation to developments in new
materials and the significance of the health of the periodontal
tissues. Cantilever bridgework is not advanced as a preferred
alternative to conventional fixed bridgework but as a means
of meeting certain clinical situations which preclude the use
of abutment supports at both ends of the bridge. Lack of
success in cantilever bridgework can frequently be aributed
to the abuse of design rather than failure of the underlying
cantilever principle.

CONCLUSION
This article describes a method for replacing wide anterior
edentulous space with modified fixed dental prosthesis
using spring cantilever. Case selection and meticulous
planning can result in spring cantilever fixed partial denture
being the most esthetic and economical answer in cases with
increased mesio-distal width of anterior edentulous space
where diastema has to be maintained. Good oral hygiene,

Kumar, et al.: Spring Cantilever

Table 2: Indications
The teeth on either side of the proposed pontic that might ordinarily
be used as abutments for fixed bridgework are unsuitable by reason
of morphology, periodontal pathology or unfavourable angulation
Cosmetic needs cannot be met by conventional fixed bridgework
The need to avoid unnecessary involvement of sound teeth is an
overriding factor on grounds of pulpal risk, cosmetic implications or the
temperament of the patient

7.

8.
9.
10.
11.

Table 3: Advantages
Readily achieved aesthetics
Relatively short clinical chairside time
Provision of diastema on either side of the pontic
Usually only one posterior abutment is required to support the
bridge
The flexible palatal bar acting as a shock absorber reduces the chances
of pontic ceramic from fracturing

patient motivation and regular follow-up contribute to an

impressive life span.

INFORMED CONSENT
A wrien consent was obtained from the three patients before
starting the treatment. They were also informed regarding
the various treatment options and the publishing protocols.

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How to cite this article: Kumar HSK, Bhat S, Patil SG, Madhavan S,
Kulkarni R. Spring cantilever: When and why - A clinical report. IJSS Case
Reports & Reviews 2014;1(4):1-4.

Source of Support: Nil, Conflict of Interest: None declared.

IJSS Case Reports & Reviews| September 2014 | Vol 1 | Issue 4