See our User Agreement and Privacy Policy. Rather than removing sound tooth structure and crowning two or more teeth—thus increasing the risk of decay and endodontic therapy (and splinting teeth together with pontics, which have the potential to cause additional tooth loss)—a dental implant may replace the single tooth (Box 1-2). A FIXED PARTIAL DENTURE (FPD) is a PD that is luted to natural teeth or tooth roots and/or affixed to dental implants that furnish the primary support for the prosthesis.1The 1-2 term BRIDGE is a non- professional term for FPD which, although common in lay person's vocabulary, should be avoided. Most fixed–fixed bridges have full coverage crown retainers: if one abutment tooth had a relatively small restoration and an inlay was use as a retainer, occlusal contact on the tooth would lead to shear stresses being generated in the cement lute, with eventual debonding and risk of secondary caries (Figure 19.7). Three main components are locked together in one FPD unit: pontic, retainer, and connector (Figure 3.12). The pontic of a fixed partial denture must be correctly related to the residual ridge and in such a manner that the contact with the mucosa is minimal. Also, the fixed partial dentures applied for patients in growing period are not suitable as they will have negative effects on bone development. Often the incisive papilla lies at the crest of the residual ridge. There exist many issues that may result when a fixed partial denture fails. It costs much less, will usually maintain the positions of the abutment teeth as well as the opposing teeth, is easy to repair, and can be constructed fairly rapidly from start to finish. These include debonding, recurrent caries, gingivitis, periodontal disease, pulpal necrosis and associated periapical disease, occlusal trauma, and fracture of the prosthesis (usually the porcelain) (Figure 11-10). Success rates for fixed partial dentures on implants in the posterior maxilla have been reported to be about 95% at 5 years and about 93% at 10 years, and the quality of bone appears to have little influence on the success rate. Often the only way the incisal edges of the pontics can be made to occlude with the opposing lower anterior teeth is to use a labial inclination that is excessive and unnatural, and both esthetics and lip support suffer. With these concerns in mind, it is mandatory that the fixed partial denture be thoroughly evaluated for mobility, fracture, occlusal trauma, pulpal health, soft tissue and periodontal response, presence of plaque, food impaction, caries, marginal integrity, function, and esthetic problems. Unfavorable outcomes of FPD failure include both the need to replace the failed prosthesis and the loss of an abutment and the need for additional pontics (replacement teeth) and abutment teeth in the replacement bridge. B. Almost 80% of abutments prepared for a three-unit FPD have no existing or only minimal restorations33,34 (Figure 1-12). The prime dental indication for placing an FPD is the patient whose abutment teeth are heavily restored and who is otherwise a good candidate for full coverage restorations on those teeth. Fixed partial dentures are susceptible to several common problems, including debonding; recurrent caries; gingivitis; periodontal disease; pulpal necrosis and associated periapical disease; occlusal trauma; or fracture of the prosthesis, usually the porcelain (Figure 9-10). Removable Partial Dentures Tooth loss is creating more partially edentulous patients In many patients fixed partial dentures are not indicated Cost of implants precludes this therapy for most patients Tooth loss patterns – A significant number of patients need extension base … Jennifer L. Brame, ... Samuel P. Nesbit, in Diagnosis and Treatment Planning in Dentistry (Third Edition), 2017. There are still some notable indications for the FPD, however. Because the central incisors are normally located anterior to this landmark, any other location of artificial central incisors is unnatural. This is most disturbing because 80% of abutments have no previous decay or are minimally restored before the fabrication of the FPD (Box 3.27).106, Carl E. Misch, in Dental Implant Prosthetics (Second Edition), 2015. Anteriorly, loss of residual bone occurs from the labial aspect. Less than half of our population in the United States has dental insurance, and of those who do, only 50% of treatment costs are reimbursed. Removable Partial Denture Versus Supported Fixed Bridge. [Crown & Bridges] [terminology & classification]. Both full and partial dentures can be used in immediate restorations. These may include not only the need to replace the failed prosthesis but also the loss of an abutment tooth and the need for additional pontics and abutment teeth in the replacement bridge. You can change your ad preferences anytime. Diagram showing all components of a three-unit FPD. The general principle is that the rigid support provided by abutments should overcome any stress levels applied on the pontics. The vertical orientation of both abutment teeth needs to be reasonably well aligned and parallel to each other (Figures 19.1, 19.5 and 19.6) to avoid undercuts. The pontic acts as a plaque reservoir in a FPD and the abutment teeth often decay (Figure 1-11). Caries and endodontic failure of the abutment teeth are the most common causes of fixed partial denture prosthesis failure.100 Caries occur more than 20% of the time and endodontic complications to the abutments of a FPD 15% of the time. [The retainer is an important appliance that unites the abutment teeth with the suspended portion of the bridge. Likewise, a cantilever FPD can be used to restore a lateral incisor with no occlusal contact on the pontic in either centric or lateral excursions. An FPD generally provides good esthetics, function, and preservation of arch form. There are two kinds of connectors, either a rigid (locked) connector or a non-rigid connector (that works like a hinge). Patients should be informed of the risks associated with the surgical placement of implants in the posterior maxilla, including sinus penetration, buccal perforation, infection, and failure to integrate, even though survival data suggest an adequate success rate for this application of dental implants. We use cookies to help provide and enhance our service and tailor content and ads. This three-tooth restoration can be fabricated within 1 to 2 weeks and satisfies the criteria of normal contour, comfort, function, esthetics, speech, and health. The adjacent teeth next to the missing tooth are prepared, and crowns are inserted that are connected to the missing tooth (pontic) (Figure 1-10). A cantilever FPD has the abutment at one end only, with the other end of the pontic remaining unattached. It can easily be unclipped and removed. The major advantage of an FPD is that the replacement teeth are fixed in place and provide a stable and natural-appearing alternative to a removable prosthesis. The most common choice to replace posterior missing teeth is a fixed partial denture (FPD).