Professional Documents
Culture Documents
Exclusions
Gross soft tissue defect
Dry mouth
Resin Bonded FPD
a) Direction of Forces.
- a well fabricated FPD can distribute applied force in the most favorable way
by directing them in
the long axis of the abutment teeth.
- The dislodging forces on a FPD retainer tend to act in a mesiodistal direction
as opposes to the more common buccolingual direction of forces in a
single restoration.
- Preparations should be modified accordingly to produce greater resistance &
structural durability
- Multiple grooves, including some on the buccal and lingual surfaces are
commonly employe for this purpose.
b) Root surface area / Area of periodontal attachment of the root to the bone
- When supporting bone is lost , the involved teeth have lessened capacity to serve as abutments,
Tylman (1970) - stated that two abutment teeth could support two pontics.
Irvin H Ante (1926) – suggested that in fixed partial prosthodontics for the observation that, the
combined pericemental area of the abutment teeth supporting a fixed partial
denture should be equal or greater in pericemental area than the tooth or teeth to
be replaced.
Johnson et al (1974) – designated “ ANTE’S LAW “ which states that the root surface area of the
abutment teeth had to equal or surpass that of the teeth being replaced with pontics
Therefore according to this premise :
One missing tooth can be successfully replaced
if abutment teeth are healthy .
Multirooted posterior teeth with widely separated roots will offer better
periodontal support than roots that converge, fuse or generally present a
conical configuration. Teeth with conical roots can be used as an
abutment for a short span FPD if all other factors are optimal.
iii) Crown - root ratio.
- This ratio is a measure of the length of the tooth occlusal to
the alveolar crest of bone compared with the length of
root embedded in the bone.
- Optimum crown-root ratio for a tooth to be utilized as
a FPD abutment is 2:3
- A ratio of 1:1 is the minimum ratio that is acceptable
for a prospective abutment under normal circumstances.
If the occlusion opposing a proposed fixed partial denture is composed of artificial teeth, the
occlusal force will be diminished with less stress on the abutment tooth.
Because of the conical shape of most roots, when one third of the
root length has been exposed half of the supporting area is lost.
In addition, the forces applied to the supporting bone are magnified because
of the greater leverage associated with the lengthened clinical crown.
Healthy periodontal tissues are prerequisites for all FPD’s and it is important that excellent plaque
removal techniques be implemented and maintained at all times.
iv) Span Length
- All FPD’s flex slightly when subjected to load.
- In addition to the increased load placed on the periodontal ligament by a long span FPD , longer
spans are less rigid and therefore flex more.
Criteria for double Abutments.
- Secondary abutments (remote from edentulous space) must have –
as much root surface area and as favorable a crown root ratio as
the primary abutment.
- The retainers on secondary abutments must be at least as retentive
as on primary abutments because when the pontic flexes tensile
forces will be applied on the retainers on the secondary abutments.
- There must also be sufficient crown length and space between
adjacent abutments to prevent impingement on the gingiva under
the connector
v) Pier Abutments
Whenever possible edentulous spaces will should be restored with FPD than RPD,
however under the following circumstances RPD is indicated.
Where vertical support from the edentulous ridge is needed .
E.g. in the absence of a distal abutment.
Where resistance to lateral movement is needed from contra-lateral teeth and
soft tissues.
E.g. to ensure stability with a long edentulous space
When there is a considerable bone loss in the visible anterior region and an FPD
would have an unacceptable appearance.
V) Sequence of treatment
Includes :
a) Treatment of symptoms
Relief of discomfort accompanying acute conditions
Urgent treatment of non-acute problems
b) Stabilization of deteriorating factors
Dental caries
Periodontal disease
c) Definitive therapy
Oral surgery, Periodontics, Endodontics, Orthodontics,
Fixed Prosthodontics – Occlusal adjustments
- Anterior restorations
- Posterior Restorations
- Complex Prosthodontics
d) Follow up specific program of follow up care & regular recall visits.
References
1) Contemporary Fixed Prosthodontics – Rosenstiel, Land & Fujimoto
2) Fundamentals of Fixed Prosthodontics – Shillingburg
3) A preliminary diagnostic and treatment protocol – J Bowley et al
DCNA.July 1992,36(3) 551-567.