Introduction

Fixed prosthodontic treatment does not last

a life time.
Patients often ask how long the bridge will
last. This is an impossible question to
answer, since most bridges do not wear
out, neither do the supporting teeth.
Failure is the result of an isolated incident,
a progressive disease process, or bad
planning or execution.

Types of failures
Biological failures
Mechanical failures
Esthetic failures

BIOLOGICAL FAILURES
Biological failures are mainly due to
Caries
Pulp degeneration
Gingival & periodontal diseases.
Occlusal problems
Tooth perforation

CARIES: It is one of the most common

biological failures.
Causes:
patients with high caries index.
Improper excavation of caries.
cementation failure leading to
marginal leakage.

Carious abutment teeth revealed by removing a

Bridge that was firmly attached to the sound abutment
Teeth.

Diagnosis:
Comprehensive probing of the
margins of the prosthesis and tooth
surfaces with a sharp explorer.
Radiographs are also helpful,
especially for interproximal lesions.

TREATMENT
Small lesions can be restored with gold foil
amalgam, composite.
In case of large lesions a new prosthesis have to
be made.
Prevention of Caries in FPD patients requires
meticulous oral hygiene procedures.
Fluoride containing dentifrices, mouth rinses and
professionally applied topical fluoride will prevent
caries.

PULP- DEGENERATION
Post insertion pulpal sensitivity on
abutment teeth that does not subside
with time, intense pain, or periapical
abnormalities that are detected
radiographically often indicates the
need for an endodontic intervention.

Treatment:
If the bridge abutment becomes non-vital
and the tooth involved is an anterior one, it
can often be treated by apicectomy.
When little sound tooth structure remains,
a post and core can be placed and a new
prosthesis can be fabricated.

GINGIVAL DISEASE
The main cause of gingival disease is
mainly due to poor oral hygiene
maintenance by the patient.
Irritation of mucosa by the pontic may be
due to the wrong choice of material for its
fit surface.
Gingival irritation caused by acrylic may be
further aggravated by the deposition of
calculus on it.

Treatment:
If the gingival disease is localized the
reason should be assessed and if
possible eliminated.
If generalized, a periodontal therapy
may be indicated.

PERIODONTAL PROBLEMS
Periodontal disease can produce
extensive bone-loss that in time
results in the loss of abutment teeth.
Localized breakdown around
prosthesis occurs as a result of
Inadequate oral hygiene maintenance

Effective plaque removal around

prostheses may be hindered due to
Poor marginal adaptation of retainers.
Over contouring of retainers
Excessively large contours that restrict the
cervical embrasure space.
Pontic, that contacts too large area on the
edentulous ridge.
Rough prostheses.

Bridge with defective

Margins and extensive
Gingival inflammation

Apically repositioned
Flap, the retainer margins
Adjusted by grinding and
polishing

Treatment
If mobility of one of the abutment
teeth is noticed, the whole prosthesis
must be reconstructed or remade to
correct such defects.

Occlusal problems
Faults in the occlusion involve
damage to the retainers and pontic by
wear and fracture.
The occlusion can change as a result
of the extraction of other teeth, or
their restoration, or through wear on
the occlusal surface.

MECHANICAL FAILURES
These include
Loss of retention
Connector failure
Pontic failure
Occlusal wear
Tooth fracture
Casting failure

LOSS OF RETENTION
causes:
Improper preparation form of tooth.
Improper cementation procedure
such as contamination with
moisture.
Because of long span of bridge.
Heavy Occlusal forces.

Diagnosis
Loss of retention can be detected in
several ways.
The patient may be aware of looseness or
sensitivity to temperature and sweets.
Patient experiences bad taste or odour
from debris accumulated.
Loose retainer can be detected, by
pressing the bridge up and down and
looking for small bubbles in the saliva at
the margins of the retainers.

Treatment
If one retainer becomes loose, it is
necessary to remove at least that
retainer, and usually the whole bridge.
If there is no extensive damage to the
preparation, it may be possible to
recement the crown or bridge.

If a fixed-fixed minimal preparation

bridge becomes loose at one end but
seems firmly attached at the other,
one option is to cut off the loose
retainer, leaving the bridge as a
cantilever.

CONNECTOR FAILURE
The connector between an abutment
retainer and a pontic or between two
pontics can fracture under Occlusal forces.
Failures of both cast & soldered
connectors have been observed and it is
generally caused by internal porosity.

Failure of solder joint is mainly due to:

A flaw or inclusion in the solder itself.
Failure to bond to the surface of the metal.
The solder joint not being sufficiently large
for the conditions in which it is placed.

OCCLUSAL WEAR
Heavy chewing forces, clenching or
bruxism can produce Occlusal wear
of a prosthesis.
When the occlusing surfaces are
restored with metal, the casting
perforation may develop after several
years .

Treatment
If the perforation is detected early, a
gold or amalgam restoration can be
placed that seals the area.
However, if the metal surrounding the
perforation is extremely thin, a new
prosthesis should be fabricated.

TOOTH FRACTURE
Tooth fracture could be
Coronal fracture
Radicular fracture

CORONAL FRACTURES
causes :
Excessive tooth reduction .
The presence of interfering centric or
eccentric Occlusal contacts.
Heavy forces on a properly adjusted
restoration.
Attempting to forcibly seat an improperly
fitting prosthesis .
Unseat a cemented bridge incorrectly.

RADICULAR FRACTURES
Root fractures are most often caused
by
Trauma
can also occur during endodontic
treatment
Forceful seating of a post & core

Treatment
Large coronal fractures necessitates
removal of the prosthesis endodontic
therapy, a post & core and a new
prosthesis.

Treatment
In cases of root fracture, when the
fracture terminates at or just below
the alveolar bone periodontal surgery
may be performed to remove bone,
and expose the fractures site so that it
can be accompanied by a new
prosthesis.
Otherwise tooth have to be extracted.

PONTIC FAILURES
Causes:
1. Faulty occlusion, particularly in
lateral excursions, which was not
corrected when the bridge was
placed.
2. Inadequate strength.

PORCELAIN FRACTURES
Porcelain fractures occurs with both
metal ceramic and all-ceramic
restorations.
Causes:
1. Improper Metal frame work design.
2. Improper occlusion.
3. Improper metal handling procedures.
4. Failure due to improper preparation,
impression and insertion.
5. Porcelain metal incompatibility.

REPAIR OF FRACTURED METALCERAMIC RESTORATIONS

The best method is the fabrication of
a new prosthesis.
Small gaps can be repaired with GIC,
composite materials (with a separate
silane coupling agent that allows
optimum bonding).

Small gap at the

mesial margin of
the upper canine
retainer.

Defect repaired
With GIC

Permanent repair when adequate

metal thickness is available:
1. Removal of the remaining porcelain
on the fractured unit to expose the
underlying metal.
2. Drilling of several pinholes (4 or 5)
into the framework to a depth of at
least 2mm and making an
impression.

3. Creation of a pin-retained metal

casting 0.2 to 0.3mm thick .
4. Fusion of porcelain to the pinretained casting and
reestablishment of normal form.
5. Cementation of the casting in
position.

PORCELAIN JACKET CROWN

FAILURES

All ceramic restorations are more

likely to fail in the presence of heavy
occlusal forces, clenching or bruxism.

VERTICAL FRACTURE
Causes:
If a tapered finish line (such as a
chamfer) is used, the restoration may
contact the tooth on a sloping surface.
Sharp areas on the prepared tooth,
such as the line angle or the incisal
edge.
A round preparation form.

FACIAL CERVICAL FRACTURE

Fracture of the facial cervical

porcelain, often assumes a half
moon shape.
Causes:
1. Short tooth preparation.
2. When the opposing tooth contact is
located incisally to the prepared
tooth.

Prevention
A shoulder of uniform width (approx
1mm)is used as gingival finish line to
provide a flat seat to resist forces directed
from the incisal.
The incisal edge should be flat and placed
at a slight inclination towards the
linguogingival to meet forces on the incisal
edge and prevent shearing.
All sharp angles should be slightly
rounded.

LINGUAL FRACTURE
Causes:
when the occlusion is located
cervically to the cingulum of the
preparation.
Inadequate lingual tooth reduction in
which less than 1mm of porcelain is
present.
Heavy Occlusal forces.

CONCLUSION
The longevity of a restoration is dependent
on many factors
The type and design of prosthesis.
The degree of functional & Para functional
loading.
The structural integrity and biologic status
of the supporting teeth & tissues.
Appropriate maintenance and home care
Precision with, which the technical and
clinical work has been carried out.