Dr.

Jogeswar Barman
FAILURES IN FIXED PARTIAL DENTURES

The causes of FPD failures were summarized as early as in 1920 when

Tinker wrote -
“Chief among the causes for such disappointing results has been:
First: Faulty, and in some cases, no attempt at diagnosis and prognosis.
Second: Failure to remove foci of infection in attention to treatment and
care of the investing tissues and mouth sanitation.
Third: Disregard for tooth form
Fourth: Absence of proper embrasures
Fifth: Inter proximal spaces
Sixth: Faulty occlusion and articulation

CLASSIFICATION

Bennard G. N. Smith

1. Loss of retention
2. Mechanical failure of crowns or bridge components
a. Porcelain fracture
b. Failure of solder joints
c. Distortion
d. Occlusal wear and perforation
e. Lost facings
3. Changes in the abutment tooth
a. Periodontal disease
b. Problems with the pulp
c. Caries
 d. Fracture of the prepared natural crown or root
e. Movement of the tooth

4. Design failures
a. Under-prescribed FPDs
b. Over-prescribed FPDs
5. Inadequate clinical or laboratory technique
a. Positive ledge
b. Negative ledge
c. Defect
d. Poor shape and color
6. Occlusal problems

TYPES OF FAILURES IN FPD

I. Cementation failure
II. Mechanical failure
III. Gingival and periodontal breakdown
IV. Caries
V. Necrosis of pulp
VI. Biomechanical failure
VII. Esthetic failure
I. CEMENTATION FAILURE Can be broadly divided into:

1. Cement failure
2. Retention failure
3. Occlusal problems
4. Distortion of FPD

1. Causes of cement failure

1) Cement selection
2) Old cement
3) Prolonged mixing time
4) Thin mix
5) Cement setting prior to seating
6) Inadequate isolation
7) Incomplete removal of temporary cement
8) Thick cement space
9) Inclusion of cotton fibers
10) Insufficient pressure

Selection of luting agent: The primary function of the luting agent is to

provide a seal preventing marginal leakage and pulp irritation. The
luting agent should not be used to provide significant retentive and
resistive forces.
An ideal luting agent would have the following properties:

1. Adequate working time

2. Adhere well to both tooth structure and metal surface
3. Provides a good seal
4. Non toxic to the pulp
5. Have adequate strength properties
6. Be compressible into thin layers
7. Have low viscosity and solubility
8. Exhibit good working time and setting properties

2. retention failure
For a restoration to accomplish its purpose, it must stay in
place on the tooth. The geometric configuration of the tooth preparation
must place the cement in compression to provide the necessary
retention and resistance.

causes for retention failure

1) Excessive taper
2) Short clinical crowns
3) Mis-fit
4) Misalignment

Excessive taper : As a cast metal or ceramic restoration is placed on or

in the preparation after the restoration has been fabricated in its final
form, the axial walls of the preparation must taper slightly to permit the
restoration to seat
Theoretically, the more nearly parallel the opposing walls of the
preparation are, the greater should be the retention.
Recommendations for optimal axial wall taper of tooth preparations
for cast restorations ranged from 10 to 12 degrees.

Short clinical crown : Cement creates a weak bond largely by

mechanical interlocks between the inner surface of the restoration and
the axial wall of the preparation. Therefore, the greater the surface area
of the preparation the greater is its retention. The preparations on large
teeth are more retentive than preparations on small teeth.
A short, over-tapered or short clinical crown would be without retention
as there would be many paths of removal.

A shorter wall cannot afford this resistance. The walls of short

preparations should have as little taper as possible.

Clinical conditions with excessive taper and short clinical crowns should
be treated with:-

1. In case of excessive taper:

a. Incorporation of proximal grooves.
b. Additional retentive grooves (should be along with the path of
insertion).
c. Additional pins

1. In case of short crowns:

a. Crown lengthening procedure
b. Modification of supra-gingival margin to sub-gingival margin
c. Additional retentive grooves and proximal box
d. Incorporation of pins
e. Addition of extra abutments

Misfit : The fit of casting can be defined best in terms of the “misfit”
measured at various points between the casting surface and the tooth.

The measurement of misfit at different locations and geometrically

related to each other and defined as :
1. Internal gap
2. Marginal gap
3. Vertical marginal discrepancy
4. Horizontal marginal discrepancy
5. Over-extended margin
6. Under-extended margin

Causes for misfit :

a. Defective casting
b. Porcelain flowed inside the retainer
c. Excessive oxide layer formation in inner side of the retainer (due to
contaminated metal or repeated firing of porcelain)
d. Tight contact points with abutment teeth
e. Incorrect manipulation of luting agents
f. Insufficient pressure during cementation procedure

Misalignment :
it is more difficult to differentiate whether a FPD is not seating because
of a faulty fit, or the alignment of the retainers relative to each other is
incorrect.
The only difference which may sometimes be apparent is that, in the
case of misalignment the FPD will have some ‘spring’ in it and tend to
seat further on pressure due to the abutment teeth moving slightly,
whereas in the case of a defective fit, the resistance felt will be solid.

Causes for misalignment

a. Abutment displacement due to improper temporization.
b. Distortion of wax pattern while sprueing and investing.
c. Casting defects.
d. Distortion of metal frameworks in porcelain firing.
e. Porcelain flow inside the retainers.
f. Misalignment of soldering points.
g. Insufficient pressure in cementation.
h. Thick cement film.
i. Excessive metal or porcelain in tissue surface (ridge lap) of pontic
prevents the proper seating of FPD and open margin (can be
detected by observing the blanching of the tissue or patient may
complain of pressure on the pontic region).

3. occlusal problems
Following the placement of a dental restoration, a patient might
report discomfort ranging from a feeling of ‘lameness’ to ‘severe and
constant pain’. Sensitivity, in most cases, is due to pulp irritation from
traumatic contact or greater leverages. When the occlusion has been
adjusted, each type of discomfort may be relieved almost instantly and
should disappear shortly.

Causes in occlusal problems

1. Immediate problems
¾ Occlusal interference
¾ Marginal ridges at different levels
¾ Supra eruption of the opposing tooth
¾ Parafunctional habits
2. Delayed problems
¾ Wearing of occlusal surface
¾ Loss of occlusal contacts
¾ Perforation of occlusal surface due to
• Porcelain Vs resin
 • Porcelain Vs gold
¾ Food lodgment due to plunger cusp
¾ Fracture of facing due to defective occlusal contact
¾ Periodontal or gingival breakdown due to improper occlusal
contacts
¾ Tenderness due to food lodgment

4. Distortion of Fpd

The completed restoration should go into place without binding of its

internal aspect against the occlusal surface or the axial walls of the
tooth preparation. In other words, the best adaptation should be at the
margins. If the indirect procedure is handled properly, there should be
no noticeable difference between the fit of a restoration on the die and
that in the mouth.

Causes of distortion:
¾ Casting defects- distorted margin, rough castings, banding of the
FPD due to improper care taken during wax pattern making,
investing and casting procedures.
¾ Bending of long span FPDs due to Thin crown, Soft metal, Heat
treatment not being done, Porosity in the metal
¾ Distortion of the metal substructure during the porcelain firing
Contaminated metal

II MECHANICAL FAILURES
Classification of mechanical failure
1. Retainer failure
2. Pontic failure
3. Connector failure

1. RETAINER FAILURE

1) Perforation
2) Marginal discrepancy
3) Facing failure
Fracture
Wearing
Discoloration
1) Perforation
Causes
a) Insufficient occlusal reduction
b) Insufficient occlusal material
c) High points in opposing dentition (plunger cusp)
d) Premature contacts
e) Contaminated metal
f) Porosity in metal work (subsurface, back pressure, suck
back)
g) Due to improper melting temperature
h) Improper pattern position
i) Improper sprue (too thin)
j) Improper location
k) Parafunctional habits

2) Marginal discrepancy

Causes
a) Selection of margin
b) Improper preparation and failure to establish the margin properly
c) Failure to do gingival retraction prevents definite margin location and
subsequently in impression
d) Selection of the impression material
i. Shrinkage in material (condensation silicon)
ii. Distortion of material (alginate)
e) Improper impression procedures
f) Voids in the impression
g) Variation in pressure application in wash technique
h) Delayed pouring of die material
i) Distortion of wax patterns at margins
j) Insufficient flow of metal
k) Shrinkage of metal
l) Nodules in margins and inner side of coping
i. Due to inadequate vacuum during investing
ii. Improper brushing technique
iii. No surfactant
m) Excessive sand blasting
n) Distortion due to degassing procedure
o) Open margins due to porcelain shrinkage (opaque porcelain)
p) Thick mixing of luting agent
q) Cement setting prior to seating
r) Insufficient pressure application during cementation

3. Facing failure

Types of veneer failures

a) Fracture
b) Wearing of facing (resin veneers)
c) Discoloration

2. PONTIC FAILURE

Factors affecting selection and failure of pontics

1) Pontic space
2) Residual ridge contour
3) Biological consideration
a. Ridge relation
b. Dental plaque
c. Gingival surface of pontic (Contact with mucosa)
i. Mucosal contact
ii. Non mucosal contact
4) Pontic ridge relationship
5) Pontic material
6) Biocompatibility
7) Occlusal forces
8) Metal substructure support

3. CONNECTOR FAILURE
The connector is that part of the FPD or splint that joins the
individual components (retainers and pontics) together.
Causes for connector failure
Improper selection of connector
Thin metal at the connector
Incorrect selection of solder
Solder gap – narrow or wide
Porosity
Insufficient metal around
Defective occlusal contacts over thin connectors

III GINGIVAL AND PERIODONTAL PROBLEMS

Margins are one of the most important and weakest links in the success
of FPD restorations. One of the prime goals of restorative therapy is to
establish a physiologic periodontal health.

A successful prosthesis depends on a healthy periodontal environment

and periodontal health depends on the continued integrity of the
prosthodontic restoration.

The margin is one of the components of the cast restoration most

susceptible to failure, both biologically and mechanically. Most of the
investigative proof shows that supragingival margins are kinder to the
gingiva than are subgingival margins. However, practicality dictates that
supragingival margins are not always usable

Failure to produce the margin of the preparation in the impression

lead to reproducing the marginal integrity of the restoration. Using of
gingival retraction technique in case of sub gingival preparation is
mandatory.
However, all displacement techniques have the potential damage
gingiva, attachment apparatus and bone, especially if anatomic forms
are weak or if disease is present.

In healthy patients, properly used cord displacement or copper band

methods have proved to be atraumatic.
IV CARIES
CAUSES
Iatrogenic (dentists’ role)
9 Failure to identify caries
9 Incomplete removal of caries
9 Marginal discrepancy with subsequent plaque accumulation
and microleakage
9 Subgingival marginal placement in inaccessible areas or
regions
9 Burning of root dentin or cementum in electro surgical
technique (leads to damage or rough surface and causes
plaque retention)
9 Over contouring of the cervical thirds of crowns or bridges
prevents the physiologic too cleaning by tongue or muscles
9 Thick cement space in margins leads to cement dissolution.
9 Narrow embrasures (inaccessibility to maintain hygiene)
9 Wide connector
Patient role
9 Systemic factors
9 Xerostomia
Due to radiation therapy
Drug induced
Endocrine disorders
9 Epilepsy (difficult to maintain the oral hygiene)
9 Rheumatoid arthritis
9 Local factors
9 Improper brushing and flossing
9 Dietary habits
9 Failure to understand importance of oral hygiene.
V PULP DEGENERATION
Pulp reactions to various procedures

Each step in full crown preparation presents hazards, which may injure
the pulp. In general, heat desiccation and / or chemical injury cause the
insult.
The result may be pulpitis or even necrosis. Among the many essential
procedures that may cause pulp injury are:
‰ Tooth preparation: excessive heat generation, over preparation with
less than 1mm of reaming dentin
‰ Impression making: irritation from the impression materials
‰ Pulp infection: from microbial infiltration due to poor oral health and
faulty temporization and cementation.

VI BIOMECHANICAL FAILURE

Causes:
Failure in selection of right abutment
Lack of retention and resistance form
Incorrect design of FPD
Wrong material selection

VII ESTHETIC FAILURES

REASONS FOR ESTHETIC FAILURE
9 Failure to identify patient expectations regarding esthetics
9 Improper shade selection
9 Excessive metal thickness at incisal and cervical regions
9 Thick opaque layer application
9 Surface blistering (chalky appearance)
9 Over glazing or too smooth a surface
9 Metal exposure in connector, cervical and incisal regions
(anteriors)
9 Failure to produce incisal and proximal translucency
9 Improper contouring
9 Failure to harmonize contra lateral tooth morphology
ƒ Contour
ƒ Color
ƒ Position
ƒ Angulation
9 Dark space in cervical third due to improper pontic selection
9 Discoloration of facing