Time to Survival for the Restoration of the Shortened Lower Dental Arch

Removable partial dentures may adversely affect remaining tissues and have a low prevalence of use. This randomized controlled trial was designed to compare the time to survival of cantilever resin-bonded fixed partial dentures and conventional removable partial dentures to restore shortened lower dental arches. We randomly allocated 25 male and 35 female patients (median age, 67 years) to fixed or removable partial denture groups of 30 persons, matched for age and sex. Survival of the prostheses was assessed, based on listed criteria, at each review or when problems arose. Although the removable partial denture group required rather more maintenance visits, the difference in survival rates was not statistically significant (hazard ratio = 0.59, with 95% CI 0.27, 1.29). In the absence of significant differences in five-year survival, the reported advantages of fixed partial dentures, including reduced maintenance frequency, offer positive support for the use of resin-bonded fixed partial dentures.

Four-Year Clinical Evaluation of GFRC-RBFPDs as Periodontal Splints to Replace Lost Anterior Teeth

PURPOSE

The aim of this study was to evaluate the clinical performance of glass fiber-reinforced composite-based resin-bonded fixed partial dentures (GFRC-RBFPDs) as periodontal splints for periodontal support-reduced anterior partially edentulous dentition and for replacing lost teeth.

MATERIALS AND METHODS

A total of 39 subjects were enrolled who required fixed restorations for lost mandibular anterior teeth where the adjacent teeth offered severely reduced periodontal support. GFRC-RBFPDs were cemented to replace the lost teeth and to stabilize the adjacent teeth. The survival rates were recorded, and the periodontal condition (bone height, bleeding index, and probing depth) was evaluated at 1, 2, 3, and 4 years after the restorations. The results were statistically analyzed with single-factor variance analysis and chi-square tests (α = .05).

RESULTS

The complete survival rate was 89.7%, and the functional survival rate was 92.3% at the fourth year. The main reason for failure was fracture of the connector of the GFRC-RBFPDs. In 21.7% of adjacent teeth, the bone height decreased; in the other 78.3%, it increased from 1 year after the restoration to the end of the observation period and the heights were statistically different from the initial values. The periodontal condition of the adjacent teeth was improved after the restoration.

CONCLUSIONS

This 4-year clinical evaluation indicated that GFRC-RBFPDs may be useful as fixed prostheses to replace one to three lost anterior teeth with damaged periodontal support in adjacent teeth.

Resin-Bonded Bridges – the Problem or the Solution? Part 2: Practical Techniques

This is the second part of this two-part series. The first paper discussed key aspects of case selection, planning and design of resin-bonded bridges (RBBs). This paper outlines the important clinical stages involved in the successful provision of RBBs, including communication with the dental laboratory, clinical protocols and management of the de-bonded RBB. Clinical relevance: This paper aims to provide the general dental practitioner with a practical guide to the successful provision of RBBs, highlighting common barriers to successful treatment and how these may be overcome.

Resin-Bonded Bridges--Can We Cement Them 'High'?

Controversy exists surrounding resin-bonded bridges (RBBs), particularly with regards to abutment preparation. Should the abutments be prepared? If the abutments are prepared what design should be adopted? If there is to be no preparation, will there be space for the restoration? Many factors need consideration when planning for this treatment. This article aims to explore the effect of abutment preparation. In this regard, a literature review was conducted to present the latest available evidence. CPD/Clinical Relevance: Minimal intervention is key in modern dentistry, so clinicians must be able to make confident decisions in the provision of minimally invasive treatments like the RBB and be aware of the latest evidence.

Resin-Bonded Bridges – the Problem or the Solution? Part 1- Assessment and Design

Resin-bonded bridges (RBBs) have an important role to play in the minimally invasive prosthodontic replacement of missing teeth. This treatment modality is perceived to have a high clinical failure rate by some practitioners, which may be associated with poorly planned and executed designs and adhesive techniques. This paper, the first part of a two-part series, discusses the important planning stages in the successful provision of RBBs, including assessment, appropriate abutment selection and design considerations. The second part of this series will focus on the clinical stages of RBB provision. Clinical relevance: This paper aims to provide the general dental practitioner with a guide to appropriate case selection and an overview of the planning stages involved for the provision of RBBs.

Use of a Resin-Bonded Bridge to Replace a Congenitally Missing Lateral Incisor: Treatment of "Intrusion" of Teeth

Craniofacial growth is an important factor to consider when providing dental implant treatment for adolescents to replace missing teeth. Ongoing longitudinal observation has demonstrated that such tooth replacements may appear intruded over time, because there may be ongoing downward and anterior movement of both the alveolus and the teeth at a rate exceeding that of the dental implant, which acts like an ankylosed unit. This case reports on a 23.5-year-old female patient who, at age 16, had orthodontics completed and was left with a space where the maxillary right lateral incisor was congenitally missing with the hope of future restoration with a dental implant. A resin-bonded bridge had been placed to fill the space in the interim. After approximately 7.5 years, the bridge loosened and the patient sought an implant option as its replacement. Clinical images revealed that the bridge, which contained two bonded wings, may have limited physiologic growth, causing both the maxillary right central incisor and canine to appear intruded compared with the left central incisor and canine. This case illustrates, at the very least, that growth and development may not be complete in females aged 16 years and that the way in which a missing tooth is replaced must be carefully considered given the impact that ongoing growth and development may have on restorative care. Moreover, further growth and development may also impact adults.

A 10-Year Clinical Evaluation of Resin-Bonded Fixed Dental Prostheses on Non-Prepared Teeth

This study evaluated the conditions of the non-invasive resin-bonded fixed dental prostheses (FDP) and patient satisfaction up to 10 years of clinical function. A total of 23 patients who required fixed prostheses in the areas of mandibular anterior and premolar, and maxillary anterior region received resin-bonded restorations between 1999-2003. In 13 patients with 14 edentulous areas were restored with an adhesive pontic (natural tooth, acrylic and porcelain). Two indirect proximal veneers using resin composite were placed in each space in 10 patients having 13 edentulous spaces. All prostheses were bonded to the proximal surface of adjacent teeth using resin cement based on 4-META/MMA-TBB. No debonding of proximal veneers but 4 pontic debonding was observed which were rebonded and remained functional until final follow up. The abutments in pontic and proximal veneer groups were free of caries and hypersensitivity. Periodontal health was improved after treatment and was maintained for 10 years except for 4 abutments that still showed some bleeding on probing. Non-invasive resin-bonded FDPs are simple, pain-free, less costly treatment procedures that could provide acceptable clinical longevity with high patient satisfaction.

Prosthodontic Rehabilitation for a Patient with Ellis-Van Creveld Syndrome: A Case Report

Patients suffering from Ellis-Van-Creveld syndrome are a challenge for dental management. Aesthetics are a major concern with limited manual dexterity, making choice of treatment critical. A 38 year old female diagnosed with Ellis-Van-Creveld syndrome presented with stained teeth and un-aesthetic smile and related that to her low self-esteem and depression. Intra-oral examination revealed mal-aligned megadont central incisors in the maxillary arch, fused mandibular canines with laterals and missing central incisors with space discrepancy and pronounced reverse over jet and overbite. Treatment involved non-surgical periodontal management, fabrication of veneers and dentine bonded crowns for maxillary anteriors and fixed-fixed resin retained bridge for mandibular arch.

Long-term Cerec 3D chairside bridges milled from IPS e.max CAD LT blocks

The experienced Cerec user can manufacture high-quality, esthetic anterior and posterior bridges from IPS e.max CAD in a manageable 3-hour chairside session. On the basis of over 8 years of experience, it can be said that these restorations are clinically very well proven, provided they are used within the range of recommended indications. Experimental retainer bridges with extensions can be seen as highly interesting alternatives, although more clinical data are required for further confirmation.

Outcome of bonded vs all-ceramic and metal- ceramic fixed prostheses for single tooth replacement

AIM

The conventional treatment of a single missing tooth is most frequently based on the provision of a fixed dental prosthesis (FDPs). A variety of designs and restorative materials are available which have an impact on the treatment outcome. Consequently, it was the aim of this review to compare resin-bonded, all-ceramic and metal-ceramic FDPs based on existing evidence.

MATERIALS AND METHODS

An electronic literature search using "metal-ceramic" AND "fixed dental prosthesis" AND "clinical, all-ceramic" AND "fixed dental prosthesis" AND "clinical, resin-bonded" AND "fixed dental prosthesis" AND "clinical, fiber reinforced composite" AND "clinical, monolithic" AND "zirconia" AND "clinical" was conducted and supplemented by the manual searching of bibliographies from articles already included.

RESULTS

A total of 258 relevant articles were identified. Metal-ceramic FDPs still show the highest survival rates of all tooth-supported restorations. Depending on the ceramic system used, all-ceramic restorations may reach comparable survival rates while the technical complications, i.e. chipping fractures of veneering materials in particular, are more frequent. Resin-bonded FDPs can be seen as long-term provisional restorations with the survival rate being higher in anterior locations and when a cantilever design is applied. Inlay-retained FDPs and the use of fiber-reinforced composites overall results in a compromised long-term prognosis. Recently advocated monolithic zirconia restorations bear the risk of low temperature degradation.

CONCLUSIONS

Several variables affect treatment planning for a given patient situation, with survival and success rates of different restorative options representing only one factor. The broad variety of designs and materials available for conventional tooth-supported restorations should still be considered as a viable treatment option for single tooth replacement.

Resin-bonded fixed dental prosthesis with a modified treatment surface in a zirconia framework: a case report

Although resin-bonded fixed dental prostheses (RBFDPs) were developed almost 40 years ago, their implementation in clinical practice did not achieve success due to biomechanical failures of the restorative materials. Nowadays, the evolution of ceramic materials and bonding procedures has allowed for the revival of the dental prosthesis. Zirconia is the dental ceramic with the highest flexural strength under compression. However, there are still some concerns regarding the bonding strength of zirconia to enamel that require further research. In this article, through the presentation of three clinical cases, the authors show how modifying the surface of zirconia frameworks by applying a feldspathic veneering on the retainer's buccal surface allows for a bonding procedure to dental structures. The goal of this treatment method is to simultaneously improve structural strength, esthetic integration, and bonding optimization to enamel. In a 3-year prospective evaluation, this framework modification shows promising results, with a survival rate of 100% and no biological or mechanical complications.

Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report

This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

Clinical evaluation of anterior all-ceramic resin-bonded fixed dental prostheses

OBJECTIVES

All-ceramic resin-bonded fixed dental prostheses (RBFDPs) were introduced as a conservative treatment many years ago. The purpose of this study was to evaluate for 8 years the clinical survival of RBFDPs made with a conventional two-retainer design.

METHOD AND MATERIALS

A total of 54 anterior RBFDPs were made from the glass-infiltrated alumina ceramic In-Ceram. The restorations were placed in 49 patients, aged 18 to 60 years, by a single operator using the same clinical procedure. The restorations were examined for debonding, fracture rate, caries, and patient acceptance. All restorations were examined clinically at 1, 2, 4, 6, and 8 years after placement.

RESULTS

At 8 years, the success rate was 85.18%. Patient acceptance was very encouraging and dental caries were not detected with any abutment. Two restorations debonded during the evaluation period and fracture of porcelain occurred in six restorations (two total fractures and four partial fractures).

CONCLUSION

All-ceramic RBFDPs made from high-strength oxide ceramics offer an effective conservative treatment for replacing anterior teeth.

All-ceramic inlay-retained fixed dental prostheses: An update

Inlay-retained fixed dental prostheses (IRFDPs) represent a minimally invasive alternative to conventional fixed dental prostheses (FDPs) to replace single posterior missing teeth. The aim of the present review article is to assess the clinical outcome of different IRFDPs in order to derive recommendations regarding their clinical application. Hence, it is essential to highlight important factors that influence the longevity and success of IRFDPs, such as treatment plan, appropriate case selection with proper indications, as well as tooth preparation. Furthermore, a good understanding of bonding technologies and awareness of pretreatment procedures for different materials are indispensable for the long-term success of IRFDPs.

Fibre-reinforced composite (FRC) bridge--a minimally destructive approach

Replacing missing teeth is an integral part of the clinical services of the dental practitioner. The fibre-reinforced composite (FRC) bridge is a relatively new method for replacing missing teeth. This article will explain and discuss this alternative treatment option. Practical instructions on how to construct a FRC bridge will be given, by means of a clinical case. Different technique options will be illustrated to provide the reader with a good understanding of the most practical way to use the FRC strips. The fibre-reinforced composite provides a non-destructive, aesthetically pleasing and cost-effective way to restore missing teeth. Clinical Relevance: Minimally invasive options should always be considered and destruction of healthy enamel and dentine during the preparation phase of a replacement treatment should be avoided as much as possible.

Three-dimensional finite element analysis of stress distribution of two-retainer and single-retainer all-ceramic resin-bonded fixed partial dentures

OBJECTIVE

A long-term clinical study previously stated that adhesively luted resin-bonded fixed partial dentures (RBFPDs) with two retainers exhibited two complications (loss of adhesion or fracture between retainer and pontic) when compared to RBFPDs with a single retainer. The reasons for these complications were not reported. The aim of this study was to evaluate the stress distribution of two-retainer and singleretainer zirconium dioxide RBFPDs by using three-dimensional finite element analysis (3D FEA).

METHOD AND MATERIALS

Two different 3D finite element models were created. Each model contained cortical bone, cancellous bone, periodontal ligament, cement, and enamel. Additionally one of the models contained a two-retainer zirconium dioxide RBFPD while another contained a single-retainer zirconium dioxide RBFPD. A 100 N force was applied at 45 degrees 2 mm below the incisal edge of the palatal surface of the pontic. In each model, Von Mises stress distribution was evaluated.

RESULTS

Maximum Von Mises stress values in RBFPD with a single retainer and two retainers were 1.13 MPa and 1.23 MPa, respectively. Von Mises stress was concentrated at the interface between pontic and retainer for RBFPD with two retainers.

CONCLUSION

Zirconium dioxide RBFPD with a single retainer and two retainers exhibited similar stress concentrations between pontic and retainer. However, the use of a single retainer for RBFPDs prevented stress concentration at the interface between retainer and pontic.

The Bond Strength of Resin Bonded Bridge Retainers to Abutments of Differing Proportions of Enamel and Composite

Four groups of specimens were constructed using bovine enamel and composite resin. After a period of ageing, the specimens were roughened and acid etched before they were cemented to air abraded base metal alloy beams with a universal resin cement. After further ageing, tensile peel testing was carried out using a Universal Testing Machine. The force required to produce failure increased as the amount of composite resin on the bonding surface of the abutment increased. This difference reached statistical significance (p < 0.5) when the abutments contained > 50% composite. The mode of failure was mixed on the majority of retainers. Within the limitations of the study, findings suggest that RBB retainers can be cemented to abutments restored with composite resin without a reduction in bond strength.

Interdisciplinary Approach for Management of Congenitally Missing Maxillary Lateral Incisors: A Case Report

Maxillary lateral incisors are frequently found congenitally missing, and their replacement has to be done prosthodontically. However, there are a variety of treatment options; a justified solution after orthodontic correction is the use of Maryland Bridges. Following is a case report of congenitally missing maxillary lateral incisors and an impacted canine and their orthodontic correction followed by prosthetic replacement of the lateral incisors using Maryland bridges.

Clinical survival of anterior metal-ceramic and all-ceramic cantilever resin-bonded fixed dental prostheses over a period of 60 months

PURPOSE

To evaluate the survival of maxillary anterior cantilever resin-bonded metalceramic (MC) and all-ceramic (AC) fixed dental prostheses (RBFDPs).

MATERIALS AND METHODS

Between August 2007 and December 2009, 40 patients received 40 RBFDPs made of either cobalt-chromium-ceramic (n = 20) or glass-infiltrated alumina (In-Ceram, Vident; n = 20) and were followed up until December 2012. Restorations were adhesively cemented (Panavia 21, Kuraray).

RESULTS

Two fractures were observed with AC. No debondings were observed with MC (n = 0) but were observed with AC (n = 3). The difference in survival rates of MC and AC was not significant (MC: 100%; AC: 90%; P = .15) (Kaplan-Meier method, confidence interval = 95%).

CONCLUSIONS

Cantilever AC RBFDPs could be a promising alternative to MC RBFDPs for replacement of missing anterior incisors, provided that no mechanical complications were experienced with the latter.

Prosthetic rehabilitation of congenitally missing canines: a case series

Hypodontia is a relatively common finding, although rarely are the canines the missing teeth. Congenitally missing canines are challenging to treat because of their unique role in the masticatory system and the fact that they are in the esthetic zone. This article discusses two patients with missing permanent canines, various treatment planning considerations, and the provided prosthetic solutions.

Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

CLINICAL RELEVANCE

When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

Bizarre tooth surface loss and the Miswak stick

Tooth surface loss can present in a variety of ways, some of which can appear rather strange on first examination. This case report demonstrates an unusual presentation of tooth surface loss (TSL) and its subsequent treatment. This loss of hard dental tissue appeared to be affecting the whole of the patient's remaining dentition, both lingually and buccally. Detailed questioning revealed the origins of this problem which turned out to be due to excessive use of an intra-oral Miswak chewing stick. Cinical Relevance: This article will enable clinicians to understand the importance of specific, targeted history-taking, involving a rare case of tooth surface loss as well as the use of minimally destructive restoration composites and a fibre-reinforced composite bridge.