A review of the success and failure characteristics of resin-bonded bridges

Full-ceramic resin-bonded fixed dental prostheses: A systematic review

Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs) are more appropriate. This study's objective was to analyze the available research on full-ceramic RBFDPs. In this study, Web of Science, MEDLINE/PubMed, Scopus, Embase, Cochrane Library, and Google Scholar databases were searched for articles published in English between 2010 and 2020. A total of 14 studies were reviewed based on the eligibility criteria. The results showed that using a cantilever design with one abutment had an advantage over two abutments. Additionally, it was proposed that preparations designed with retentive aids, such as a proximal box, groove, and pinhole, could improve RBFDP survival rates. IPS e.max ZirCAD, In-Ceram alumina, and zirconia CAD/CAM were the most commonly used framework materials. Most studies used air abrasion, salinization, or hydrofluoric acid for surface treatment. Adhesive resin cements were the most frequently used type of cement. The survival rate of In-Ceram ceramics (85.3%-94.8%) was lower than that of In-Ceram zirconia and IPS e.max ZirCAD. Debonding, followed by framework fracture, was the leading cause of failure. Following 3-10 years follow-up, the survival percentage of all-ceramic RBFDPs ranged from 76% to 100%. Although RBFDPs have demonstrated satisfactory success as a conservative treatment, long-term follow-ups and higher sample sizes in clinical research are required to gain more reliable outcomes on the clinical success rate of various RBFDP designs.

The cantilever contact-point resin bonded bridge; adhesion 2.0

AIM

When young patients are congenitally missing anterior teeth, different treatment modalities can be used to complement the dental arch. This article proposes a new treatment modality for the replacement of anterior teeth, the cantilever contact-point resin bonded bridge (CCP-RBB).

MATERIALS AND METHODS

In this proof of principle study, CCP-RBB's delivered by one operator were clinically assessed. Patients who were missing maxillary incisors and had suitable intra-oral conditions for a contact-point cantilever RBB were included. Three cases are presented to describe all adhesive steps. This proof of principle clinical study is presented with up to 60 months follow-up of the cantilever contact resin bonded bridges.

RESULTS

A total of 19 CCP-RBB's were evaluated after a mean period of 29.8 months. None of the restorations exhibited failure, carious lesions or fractures during the follow-up periods, demonstrating an absence of restoration debonding or the need for repair.

CONCLUSION

The new cantilever contact-point resin bonded bridge exhibited an excellent treatment modality without failure or debonding up to 5 years. More and extended duration in vivo studies are needed to evaluate this new treatment modality.

CLINICAL SIGNIFICANCE

In this proof of principle the new cantilever contact-point resin bonded bridge obtained excellent results up to 5 years of clinical follow-up.

Terminology focused on design and retention methods used for anterior resin-bonded fixed partial dentures in English literature: A scoping review

Purpose

Novel terms describing several designs of resin-bonded fixed partial dentures (RBFPDs) continue to appear. Indeed, a variety of terms are used in the English scientific literature The use of a standard terminology is important for a fair and efficient understanding. This study aimed to investigate if the terminology used to describe designs and retention methods for anterior RBFPDs is standard.

Methods

An electronic search in the English literature was conducted in PubMed/Medline to identify all publications reporting RBFPDs in the anterior region until August 2022. This search was completed by hand searching. Terms indicating different designs of RBFPDs were listed and then classified. Percentages of their use were calculated to determine the commonly used terms. Analysis of the use of these terms was performed based on the standards determined by the latest edition of the Glossary of Prosthodontic Terms (GPT). The impacts of the MeSH Thesaurus and GPT on the nomenclature used for RBFPDs was assessed.

Results

A total of 125 articles were eligible for this review. In the retained articles, 86 terms were found. Among them, thirty-nine terms were classified into three groups. Only six terms were defined in the latest edition of GPT (GPT-9). Several classified terms that are commonly used were not identified in the GPT-9. Conversely to the GPT-9 which impact was insignificant, the MeSH Thesaurus had an important impact on the nomenclature used for RBFPDs.

Conclusion

The terminology used to describe designs and retention methods for anterior RBFPDs was non-standard. The GPT-9, constituting an important reference, defined a limited number of terms related to RBFPDs and had no significant impact on the standardization of the terminology used for RBFPDs. Efforts should therefore be continued to standardize the terminology. A specialized mini-glossary grouping and defining all the terms found in this study will helpful in clarifying the terminology used for the anterior RBFPDs.

Practical advice for successful clinical treatment with resin-bonded bridges

Resin-bonded bridges are one of the main options for replacing missing teeth for hypodontia patients. This technique offers several advantages for these patients, who are often young, have unrestored abutment teeth, and have had tooth positions optimised by orthodontic treatment. However, the replacement of missing teeth can be challenging due to tooth positions and anomalies of abutment tooth shape and size.These patients are often young adults at the time of restoration, making the minimally invasive nature and predictable long-term success of resin-bonded bridges advantageous over other treatment methods.This paper in the hypodontia themed issue discusses the importance of case selection and gives practical advice for the design and provision of resin-bonded bridges.

A 32-month evaluation of lithium disilicate cantilever resin-bonded fixed dental prostheses to replace a missing maxillary incisor

STATEMENT OF PROBLEM

The absence of a tooth in the esthetic zone can cause emotional and social distress. The use of minimally invasive and visually pleasing lithium disilicate resin-bonded fixed dental prostheses (RBFDPs) may be a suitable option for replacing a missing maxillary incisor. However, the available literature on lithium disilicate cantilever RBFDPs is limited.

PURPOSE

This retrospective multicenter study assessed the survival and success rates of lithium disilicate anterior cantilever RBFDPs with an average follow-up period of 3 years up to 9 years.

MATERIAL AND METHODS

RBFDPs delivered by 3 operators were clinically assessed for survival using a modified United States Public Health Service criteria list. The incidence density was determined for each criterion and operator. The standard error and 95% confidence interval were calculated for each incidence density difference (α=.05 for all analyses).

RESULTS

A total of 108 RBFDPs were evaluated after a mean period of 32.45 months, ranging from 14 days to 111 months. None of the restorations exhibited failure, carious lesions, or fractures during the follow-up period. The primary reasons for reduced success rates were inflammation of the surrounding soft tissues and discoloration, with incidence densities of 0.074 and 0.057 per year, respectively. Significant differences were observed among RBFDPs from different operators for criteria that included adaptation, color match, marginal adaptation, polishability, surface staining, gingival health, and antagonist wear.

CONCLUSIONS

Cantilever lithium disilicate RBFDPs appear to be suitable for short-term restoration. RBFDPs exhibited visible changes after short-term follow-up. However, these changes did not result in failure.

Designing anterior cantilever resin-bonded fixed dental prostheses based on finite element analysis

PURPOSE

A resin-bonded bridge (RBB) is a minimally invasive prosthetic treatment option for intact adjacent teeth. However, it is contentious as to whether the mesial or distal adjacent tooth should be used as an abutment. This study aimed to investigate the potential of finite element analysis (FEA) for the selection of abutment teeth and the determination of the optimal design for anterior cantilever RBBs.

METHODS

Three types of RBBs were designed to simulate loss of the maxillary left lateral incisor. The fixed-fixed RBB (FF-RBB) had one retainer each for the left central incisor and canine. Distal- and mesial-cantilever RBBs (D-CRBB and M-CRBB) had a single retainer on the central incisor and canine, respectively. Three-dimensional models for FEA were generated from computed tomography slices and dental casts. FEA was performed for each RBB to evaluate stresses in the intercuspal, protrusive, and lateral mandibular positions.

RESULTS

The maximum principal stresses on the bridges in the intercuspal position were 141.9 MPa, 93.6 MPa, and 45.7 MPa, for the FF-RBB, D-CRBB, and M-CRBB, respectively. The stress in the D-CRBB position was greater than in the M-CRBB position in the intercuspal, protrusive, and lateral mandibular positions.

CONCLUSIONS

Based on the results, M-CRBB on the canine had a higher clinical performance than D-CRBB on the central incisor. FEA was useful for determining the optimal design of RBB for each patient.

Interdisciplinary Management of Bilateral Congenital Lateral Incisor Agenesis

Management of lateral incisor agenesis is a real challenge and needs a strong collaboration between surgical, aesthetic, and orthodontic dentistry. This case report managed upper lateral incisor agenesis with an orthodontic treatment leading to open spaces and placement of cuspids in lateral incisor area to avoid implant placement in maxillary anterior region. Temporary rehabilitation phase, using resin injected tray and removable partial denture, has been placed to maintain mesiodistal dimensions and restore aesthetic during pre-implant analysis and osseointegration. Once osseointegration was fully obtained, keratinized tissue augmentation has been obtained using connective tissue graft. Then, temporary implant fixed crowns allowed soft tissue modeling during interim rehabilitation. Finally, screw-retained permanent crowns were placed to fully restore aesthetic and function. This case goal was to optimize final results and reach patient complete satisfaction using orthodontic treatment combined with implant rehabilitation, and coupled with interdisciplinary management and well-time sequencing treatment.

Restorative dentistry in the young cleft patient

This clinical paper outlines the role of the restorative consultant in the treatment of young cleft lip and palate patients up to the end of their cleft package of care on their 22nd birthday. The multidisciplinary nature of the care is highlighted, including the role of the general dental practitioner in caring for cleft patients in primary care. The various clinical treatment modalities used in this patient group are described with an emphasis on minimally invasive and adhesive approaches. The role of dental implants and removable prostheses are described. Considerations for long-term maintenance, much of which will take place in primary care, are also included.

The Success Rate of the Adhesive Partial Fixed Prosthesis after Five Years: A Systematic Review

Objective: Evaluation of the success and/or survival rates of resin-bonded fixed partial dentures (RBFPDs) reported in the scientific literature with a minimum average observation time of five years. Materials and Methods: Search conducted in Pubmed, Web of Science, and Cochrane databases in free-text format and MESH terms, until May 2021. The random-effects model was used for the estimated survival rate, percentage per year of estimated failure, and existing complications for the meta-analysis. Study heterogeneity was assessed by the inconsistency test (I2) and study quality by the Downs and Black scale. Results: Eleven articles were included, with 687 participants and 783 RBFPDs, with a mean observation time of 8.2 years, with success rates mentioned in three articles and survival rates reported in nine articles. A total of 142 failures were reported for 783 prostheses, the most frequent being debonding. The estimated failure rate was between 0.53% and 5.10% per year. The studies were of sufficient quality. In the meta-analysis, the survival rates showed a significant result (p < 0.001), with moderate heterogeneity (I2 = 58.76%). Conclusions: Within the limitations of this research, mainly related to the heterogeneity of the studies and their quality, it seems possible to conclude that RBFPDs are a viable clinical option for the rehabilitation of patients with single edentulous spaces, mainly when using a single retainer and a zirconia-ceramic prosthesis.

Structural Integrity of Anterior Ceramic Resin-Bonded Fixed Partial Denture: A Finite Element Analysis Study

This study was conducted as a means to evaluate the stress distribution patterns of anterior ceramic resin-bonded fixed partial dentures derived from different materials and numerous connector designs that had various loading conditions imposed onto them through the utilization of the finite element method. A finite element model was established on the basis of the cone beam computed tomography image of a cantilevered resin-bonded fixed partial denture with a central incisor as an abutment and a lateral incisor as a pontic. Sixteen finite element models representing different conditions were simulated with lithium disilicate and zirconia. Connector height, width, and shape were set as the geometric parameters. Static loads of 100 N, 150 N, and 200 N were applied at 45 degrees to the pontic. The maximum equivalent stress values obtained for all finite element models were compared with the ultimate strengths of their materials. Higher load exhibited greater maximum equivalent stress in both materials, regardless of the connector width and shape. Loadings of 200 N and 150 N that were correspondingly simulated on lithium disilicate prostheses of all shapes and dimensions resulted in connector fractures. On the contrary, loadings of 200 N, 150 N, and 100 N with rectangular-shaped connectors correspondingly simulated on zirconia were able to withstand the loads. However, two of the trapezoidal-shaped zirconia connectors were unable to withstand the loads and resulted in fractures. It can be deduced that material type, shape, and connector dimensions concurrently influenced the integrity of the bridge.

Reconstruction of Natural Smile and Splinting with Natural Tooth Pontic Fiber-Reinforced Composite Bridge

Teeth replacement is challenging in old patients with severe periodontal disease, limiting prosthetics treatment options. Here, we report a fiber-reinforced composite (FRC) resin bridge using natural tooth pontic in a patient with severe periodontitis. A 60-year-old lady complaining of teeth mobility was diagnosed with severe periodontitis, recession, bone loss, and crowding in the anterior maxillary teeth. Due to a hopeless periodontal prognosis, lateral incisors were extracted and sectioned using a cylindrical diamond bur. The pulp chamber was debrided and filled with self-adhesive flowable composite resin. After three weeks, the pontics were fixed in proximal contact areas, and the FRC bridge was fabricated directly using the resin fiber strip followed by occlusion adjustment, finishing, and polishing. Esthetic, occlusion, and periodontal status were re-evaluated after six months. Here, FRC using natural pontic could successfully reconstruct a natural smile, splint the adjacent teeth, eliminate crowding, and provide stable occlusion. Therefore, this method may be considered for similar cases.

Comparison of Tensile Bond Strength of Fixed-Fixed Versus Cantilever Single- and Double-Abutted Resin-Bonded Bridges Dental Prosthesis

Resin-bonded fixed dental prostheses (RBFDP) are minimally invasive alternatives to traditional full-coverage fixed partial dentures as they rely on resin cements for retention. This study compared and evaluated the tensile bond strength of three different resin-bonded bridge designs, namely, three-unit fixed-fixed, two-unit cantilever single abutment, and three-unit cantilever double-abutted resin-bonded bridge. Furthermore, the study attempted to compare the tensile bond strengths of the Maryland and Rochette types of resin-bonded bridges. Based on the inclusion and exclusion criteria, a total of seventy-five extracted maxillary incisors were collected and later were mounted on the acrylic blocks. Three distinct resin-bonded metal frameworks were designed: three-unit fixed-fixed (n = 30), two-unit cantilever single abutment (n = 30), and a three-unit cantilever double abutment (n = 30). The main groups were further divided into two subgroups based on the retainer design such as Rochette and Maryland. The different prosthesis designs were cemented to the prepared teeth. Later, abutment preparations were made on all specimens keeping the preparation as minimally invasive and esthetic oriented. Impression of the preparations were made using polyvinyl siloxane impression material, followed by pouring cast using die stone. A U-shaped handle of 1.5 mm diameter sprue wax with a 3 mm hole in between was attached to the occlusal surface of each pattern. The wax patterns were sprued and cast in a cobalt-chromium alloy. The castings were cleaned by sandblasting, followed by finishing and polishing. Lastly, based on the study group, specimens for Rochette bridge were perforated to provide mechanical retention between resin cement and metal, whereas the remaining 15 specimens were sandblasted on the palatal side to provide mechanical retention (Maryland bridge). In order to evaluate the tensile bond strength, the specimens were subjected to tensile forces on a universal testing machine with a uniform crosshead speed. The fixed-fixed partial prosthesis proved superior to both cantilever designs, whereas the single abutment cantilever design showed the lowest tensile bond strength. Maryland bridges uniformly showed higher bond strengths across all framework designs. Within the limitations of this study, the three-unit fixed-fixed design and Maryland bridges had greater bond strengths, implying that they may demonstrate lower clinical failure than cantilever designs and Rochette bridges.

Debonding of cast metal-based cantilever and fixed-fixed resin-retained bridgework: A review of the literature

AIM

Cast metal-based resin-retained bridgework (RRB) offers a practical, conservative approach when restoring edentulous spaces. This review examines the debonding of cast metal-based RRB, comparing cantilever resin-retained bridgework (CRRB) and fixed-fixed resin-retained bridgework (FRRB) designs taking into context developments in RRB design, construction, and cementation over time.

METHODS

An electronic search was conducted through Medline and Embase with the aid of Boolean operators to combine the following key words: "adhesive bridges", "resin-bonded bridges", "resin-retained bridges", "resin-bonded fixed partial dentures", "cantilever", "debond", "fixed-fixed", "decementation", "failure", "success", "outcome", "longevity" and "survival". The search was limited to peer-reviewed articles written in English and published from 1995 through to 2019.

MAIN FINDINGS

Thirty-one studies were included. Five studies compared the longevity of CRRB versus FRRB, five assessed the clinical performance of CRRBs alone, and 21 studies assessed the clinical performance of FRRBs. There was great variability in study design and the reporting of clinical outcomes, and an analysis and critique of the included papers is provided. Overall, CRRB tend to debond less and hence provide longer-term and more reliable clinical service when compared to FRRB.

PRINCIPAL CONCLUSIONS

More high-level, long-term, prospective and clinical controlled trials are required to further analyse and evaluate the long-term outcomes of cast metal-based RRB.

Critical review about two myths in fixed dental prostheses: Full-Coverage vs. Resin-Bonded, non-Cantilever vs. Cantilever

The purpose of this review was to assess the literature regarding four types of fixed dental prostheses (FDPs)/resin-bonded FDPs (RBFDPs) to provide clinicians with a comparative overview of two myths: “RBFDPs are easy to debond in patients’ mouths” and “cantilever RBFDPs still have some clinical problems, especially in terms of overloading the abutment teeth and being easy to debond”. A total of 782 papers were identified, 753 of which were judged unsuitable and thus excluded, leaving a total of 29 articles for inclusion in this review. The results indicated that 1) Two-retainer RBFDPs achieve clinical results comparable to full-coverage three-unit FDPs; 2) Cantilever RBFDPs show excellent long-term clinical outcomes (especially in incisor teeth) compared with other FDPs; 3) RBFDPs typically show less catastrophic failure than conventional FDPs, rebonding should be considered when debonding occurs; and 4) Cantilever RBFDPs can be recommended as defect replacement prostheses for maxillary lateral incisors and mandibular incisor teeth.

Scientific field: Prosthodontics, Adhesive dentistry, Esthetic dentistry

Scaffold-based developmental tissue engineering strategies for ectodermal organ regeneration

Tissue engineering (TE) is a multidisciplinary research field aiming at the regeneration, restoration, or replacement of damaged tissues and organs. Classical TE approaches combine scaffolds, cells and soluble factors to fabricate constructs mimicking the native tissue to be regenerated. However, to date, limited success in clinical translations has been achieved by classical TE approaches, because of the lack of satisfactory biomorphological and biofunctional features of the obtained constructs. Developmental TE has emerged as a novel TE paradigm to obtain tissues and organs with correct biomorphology and biofunctionality by mimicking the morphogenetic processes leading to the tissue/organ generation in the embryo. Ectodermal appendages, for instance, develop in vivo by sequential interactions between epithelium and mesenchyme, in a process known as secondary induction. A fine artificial replication of these complex interactions can potentially lead to the fabrication of the tissues/organs to be regenerated. Successful developmental TE applications have been reported, in vitro and in vivo, for ectodermal appendages such as teeth, hair follicles and glands. Developmental TE strategies require an accurate selection of cell sources, scaffolds and cell culture configurations to allow for the correct replication of the in vivo morphogenetic cues. Herein, we describe and discuss the emergence of this TE paradigm by reviewing the achievements obtained so far in developmental TE 3D scaffolds for teeth, hair follicles, and salivary and lacrimal glands, with particular focus on the selection of biomaterials and cell culture configurations.

An 8-Year Clinical Outcome of Posterior Inlay Retained Resin Bonded Fixed Dental Prosthesis Utilizing High Performance Polymer Materials: A Clinical Report

This clinical report presents the use of a modified polyetheretherketone (PEEK) Inlay Retained Resin Bonded Fixed Dental Prosthesis (IRRBFDP) framework, veneered with indirect high impact composite for the bilateral restoration of mandibular first molar teeth, as the most conservative treatment option for a medically compromised patient. When used as a framework, PEEK's elastic modulus (approximately 4 GPa), could result in the reduction of stresses transferred to the abutment teeth and the cementation interface accordingly, therefore it could result in lower de-bonding rates and higher success rates. Furthermore, the high bond strength with the veneering composite material and the luting cements permit its use for resin-bonded restorations. Preparation guidelines, indications and advantages for the fabrication of IRRBFDPs are described in this clinical report. No technical complications such as de-bonding of the framework, connector or retainer fracture of the adhesive frameworks or loss of retention were observed during the course of 8 years. Prosthetic replacement of single missing posterior mandibular teeth utilizing IRRBFDPs with high performance polymer materials could potentially offer long-term high survival rate outcomes. Further clinical evidence is required in order to justify the above statement.

Ten-year clinical evaluation of posterior fixed-movable resin-bonded fixed partial dentures

OBJECTIVES

Two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) offer long-term retention for anterior and premolar-sized spans. At this center, molar and longer spans have been restored with fixed-movable (FM) RBFPDs to overcome the lower retention rates of fixed-fixed RBFPDs. This retrospective study aimed to evaluate the long-term longevity and the patient-reported outcomes of posterior FM-RBFPDs.

METHODS

Posterior FM-RBFPDs that had been inserted at least five years were reviewed. Survival was "retention of the original prosthesis in mouth" and success was "survival of prosthesis and absence of complications requiring treatment intervention". Prosthesis location, number of units, insertion year, tooth/teeth replaced and operator experience were collected. Patients' acceptance to FM-RBFPDs were assessed using prosthesis satisfaction questionnaire and Oral Health Impact Profile (OHIP-49). Results were analyzed using log-rank and cox-regression tests at significance level α = 0.05.

RESULTS

One-hundred-and-one prostheses were examined. The mean observation time was 126.4 ± 32.2 months. Thirty-six (35.6%) and 63 (62.4%) FM-RBFPDs were rated as success and survival respectively. Prostheses inserted after year 2001 (n = 69) experienced 42.0% (n = 29) success and 75.4% (n = 52) survival, and its survival rate was significantly better than those inserted in or before 2001 (p = 0.01). Five- and ten-year cumulative survival probability of FM-RBFPDs inserted after year 2001 were 82.3% and 74.1% respectively. The most frequent complications were debonding among 34 (33.7%) prostheses. Patients' acceptance were high.

CONCLUSIONS

More recently inserted prostheses showed improved longevity and patients' acceptance to posterior FM-RBFPDs were high.

CLINICAL SIGNIFICANCE

Fix-Movable RBFPDs are a viable tooth replacement option in the posterior region.

Effects of Fibers on Color and Translucency Changes of Bulk-Fill and Anterior Composites after Accelerated Aging

The aim of this study was to determine the effects of glass and polyethylene fibers on the color and translucency change of bulk-fill and anterior composites before and after artificial accelerated aging (AAA). Two types of teflon molds were used to fabricate samples which were 13 mm in diameter and, respectively, 2 mm and 4 mm in height. Polyethylene fiber (PF) and glass fiber (GF) were incorporated in the middle of the composite samples. Color and translucency changes of each composite were evaluated before and after AAA with spectrophotometer. ANOVA and Tukey's HSD post hoc statistical analysis were used at a significance level of 0.05. Before AAA (for anterior composites), there were no significant differences in L^* and b^* parameters among the three groups (p > 0.05); there were no significant differences in L^* parameter between PF and GF groups or in TP between GF and control groups (p > 0.05) (for bulk-fill composites). After AAA, there were no significant differences in L^* parameter between GF and control groups, in a^* parameter between PF and control groups, in b^* parameter among all groups, or in TP parameter between GF and control groups (p > 0.05). Fiber reinforcement led to color and TP change in both anterior and bulk-fill resin composites.

Longevity of anterior resin-bonded bridges: survival rates of two tooth preparation designs

BACKGROUND

Significant developments have occurred in the design of resin-bonded bridges (RBB) over the past two decades. They are commonly used as an alternative treatment option for a single missing tooth. The longevity of these bridges needs to be further investigated to evaluate long-term outcomes for this option to remain relevant.

METHODS

A cohort of patients who received anterior resin-bonded bridges (ARBB) over two decades was studied retrospectively. Longevity of 206 ARBB was assessed using Kaplan-Meier probability estimates. The two modified tooth preparation designs investigated were: (A) mesial and distal vertical grooves only; and (B) one proximal groove adjacent to the pontic and two palatal grooves. Age and gender of the patient cohort were also recorded.

RESULTS

Overall survival rate of ARBB was 98% at 5 years, 97.2% at 10 years, and 95.1% from 12 years till 21 years. Survival curves showed minor differences when compared for the two designs, age groups and gender of ARBB recipients. Differences in the proportion of surviving bridges for design A (95.96%) and design B (98.13%) were not statistically significant (Fisher's exact test).

CONCLUSIONS

Anterior RBB with described tooth preparation designs demonstrate a high survival rate.

Aspects of Malpractice in Prosthodontics

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.

Fiber-reinforced composite fixed dental prostheses: A 4-year prospective clinical trial evaluating survival, quality, and effects on surrounding periodontal tissues

STATEMENT OF PROBLEM

Although fiber-reinforced composite fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth, comparatively few prospective clinical trials (PCT) exist.

PURPOSE

The purpose of this PCT was to evaluate the survival, quality outcome, and effect of FRC FDPs on periodontal health over 4 years.

MATERIAL AND METHODS

Twenty-six consecutive patients (16 men, 10 women) receiving FRC FDPs with preimpregnated unidirectional fiber reinforcement were included in the trial. Eighteen FRC FDPs were placed in the maxilla and 8 in the mandible. Data from baseline, 12-, 36-, and 48-months of follow-up were recorded, and the prostheses were classified as "success," "survival," or "failure." Periodontal parameters (probing depth, clinical attachment level, plaque index, and bleeding index were assessed, and the quality was rated according to modified United States Public Health Service (USPHS)/Ryge or World Dental Federation (FDI) criteria.

RESULTS

Functional survival at 4 years was 73.5% (95% confidence interval [CI], 52.9-87.3) with 17 FRC FDPs still functioning. Twelve of these were classified as "success" and 5 as "survival." Overall survival was 53.0% (95% CI, 30.4-74.4). Six FRC FPDs failed completely. Periodontal parameters did not change over the observation period. Regression analysis showed that probing depth and clinical attachment level did not influence the survival of FRC FDPs. According to USPHS/Ryge/FDI criteria only "wear" and "surface luster" increased significantly over 4 years.

CONCLUSIONS

The survival rate of FRC FPDs confirms existing data. Negative effects on periodontal health were not seen over the period of observation. Aging effects such as wear were recorded and indicated that FRC FPDs are at risk of disintegration, as they are composed of a fiber framework and veneering composite resin.

Longevity of fiber-reinforced composite fixed partial dentures (FRC FPD)-Systematic review

OBJECTIVES

to assess FRC FPDs longevity through systematically reviewing contemporary clinical evidence. Population investigated comprised patients requiring replacement of a single missing anterior/posterior tooth. Intervention was FRC FPDs. No control/comparison selected. Outcome was longevity of FRC FPDs. The focus question was: 'What is the longevity of FRC FPDs used to replace one anterior or posterior tooth in patients?'

DATA

Randomised, non-randomised, controlled, prospective and retrospective clinical studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were applied. The Overall Strength of Clinical Recommendation (OSCR) was assessed using the Strength of Recommendation Taxonomy system. Survival of FPDs was assessed using the Kaplan-Meier method. Analysis of FPD-survival according to location and occurrence of different failures was performed using Logrank and Chi-square testing.

SOURCES

PubMed, MEDLINE, and Web of Science databases were searched between January 2007 and December 2015.

STUDY SELECTION

Nine studies were included, involving placement of 592 FRC FPDs in 463 patients. Follow-up periods ranged between 2 months and 8 years. Kaplan-Meier overall survival probability was 94.5% (95%C.I: 92.5%-96.5%) at 4.8 years. There was no significant difference in survival probability of anterior versus posterior FRC FPDs (P=0.278). Veneering material fracture/delamination occurred significantly more than other types of failures (Ps<0.05). A meta-analysis could not be performed. OSCR was moderate.

CONCLUSIONS

FRC FPDs demonstrated high overall survival with predictable performance outcomes. However, long-term performance remains unclear.

CLINICAL SIGNIFICANCE

FRC FPDs are viable medium-term management alternatives for replacing single anterior or posterior teeth in patients.

The Use of All-Ceramic Resin-Bonded Bridges in the Anterior Aesthetic Zone

For several years, all-ceramic resin-bonded bridges (RBBs) have been considered an aesthetic treatment option for the replacement of missing teeth in the anterior region. With continued developments in technology, various different ceramic materials have been used to fabricate all-ceramic RBBs including zirconia, glass-reinforced, alumina-based ceramics, and lithium disilicate glass ceramics. The aim of this article is to provide an overview of all-ceramic RBBs, the advantages and disadvantages associated with these prostheses, as well as to demonstrate their application in replacing missing anterior teeth. Clinical relevance: To present the current literature and clinical application of all-ceramic resin-bonded bridges for replacing missing anterior 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.

Attitude and awareness of dentist towards resin bonded bridges in Saudi Arabia

STATEMENT OF THE PROBLEM

Resin bonded bridges (RBBs) offer a conservative approach to tooth replacement. However, the use of this treatment option has been limited. Therefore, the aim of this study was to assess the knowledge and attitude of dentists in Saudi Arabia, including general dental practitioners (GDPs) and prosthodontic and restorative specialists (SPs), toward RBBs.

METHODS

In this cross-sectional study, questionnaires designed to survey knowledge of RBB performance factors were distributed to GDPs and SPs (n = 400). Specifically, opinions of GDPs and SPs regarding clinical, mechanical, technique- and patient-dependent performance factors of RBBs were obtained. Average significance and Chi-square tests were used to identify the frequency, pattern, and significance of the response variables identified.

RESULTS

A majority (65.3%) of the subjects reported using RBBs in less than 10% of their prosthodontic cases. The most common reason for the limited clinical application of RBBs was perceived poor retention (23.45%). In addition, SPs regarded the influence of enamel structure, number of pontics, cement type, RBB design, and surface treatment as "very significant" factors with respect to RBB survival. Overall, a statistically significant difference was observed between the responses of GDPs and SPs regarding their knowledge of performance factors for RBBs.

CONCLUSION

In comparison to SPs, GDPs reported greater disagreement with current standards for RBB success factors. Moreover, 60% of SPs and 71% of GDPs used RBBs for less than 10% of their prosthodontic cases. Therefore, continuing education opportunities are needed for practicing dentists, and undergraduate students need to receive greater exposure to the clinical application of RBBs.