Group G

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 Can restorations can last “a lifetime”?
 Permanent restorations are not permanent
 May fail in time
 Sparks legal cases between patients
 Thus before any treatment
 determine patient's expectations
 ensure the health of the soft tissues before treating
the hard tissues.
 In restorative dentistry 'beauty is in the eye of
the owner'!
Gilmour G, BDJ 3
 Survival was defined as the reconstruction
remaining in situ at the follow-up examination
visit irrespective of its condition.
 Whether the restoration is still physically within the
oral cavity
 Success was defined as the reconstruction that
remained unchanged and did not require
any intervention during the entire observation
period.
 Free of disease, fulfills criteria of function, comfort,
aesthetics
Pjetursson et. al 4
 the branch of prosthodontics concerned with
the replacement and/or restoration of teeth by
artificial substitutes that not readily removed
from the mouth

THE GLOSSARY OF
PROSTHODONTIC TERMS –
ACADEMY OF PROSTHODONTICS 5
 an artificial replacement that restores missing
tooth structure by surrounding part or all of the
remaining structure with a material such as
 cast metal (full metal crown)
 porcelain (all ceramic crown)
 or a combination of materials such as metal and
porcelain (porcelain-fused-metal crown)

THE GLOSSARY OF
PROSTHODONTIC TERMS –
ACADEMY OF PROSTHODONTICS 6
ALL CERAMIC CROWN

PORCELAIN FUSED METAL

FULL METAL CROWN

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 any dental prosthesis that is luted, screwed or
mechanically attached or otherwise securely retained
to natural teeth, tooth roots, and/or dental implant
abutments that furnish the primary support for the
dental prosthesis
 In other words, it is a prosthesis used to replace one or
more teeth and joined permanently with adjacent teeth
or dental implants
 Types:
Conventional bridge, Minimal preparation bridge

THE GLOSSARY OF
PROSTHODONTIC TERMS –
ACADEMY OF PROSTHODONTICS 8
CONVENTIONAL BRIDGES

MINIMAL PREPARATION BRIDGE

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 Biological
 Mechanical
 Technical
 Esthetic

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 Caries
 Periodontal disease
 Abutment fracture
 Pulp injury

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 Caries
 Second most frequent biological complication
in fixed prosthodontics.
 Caused by
 Marginal leakage
 Poor oral hygiene
 “Dental caries leading to loss of fixed
prosthesis in estimated 10 years cumulative
rate was 2.6 %”

Pjetursson et. al 12
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 Periodontal disease
 Inadequate abutment teeth
 Periodontally affected abutment
 Poor oral hygiene
 Poorly designed/constructed prosthesis
 “The estimated 10 year cumulative rate of fixed
partial denture lost to recurrent periodontitis was 1%”

Pjetursson et. al 14
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 Abutment fracture
 Coronal
 Root

Some representative failure modes after the fracture test:

(A) oblique fracture in the cervical portion of the crown
(B) longitudinal fracture in the cervical portion of the crown
(C) longitudinal fracture in the cervical portion of the crown
(D) oblique fracture in the cervical portion of root .
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 Pulp injury
 Over-heating
 Over-reduction
 Pulp exposure
 Inadequate protection
 Recurrent caries
 “The estimated 10 year cumulative rate of FPDs lost
to loss of the abutment vitality was 32.6%”

Pjetursson et. al 17
 Prosthesis fracture
 Looseness/dislodgement
 Occlusal wear/perforation

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 Prosthesis fracture

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 Looseness/dislodgement

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 Occlusal wear/perforation

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 Fracture of framework
 Chipping of veneer ceramic
 Marginal gap/discolouration
 Loss of retention

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 Immediate
 Delayed

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 Immediate
 Colour mismatch
 Poor contour
 Metal display
 Improper pontic placement
 Inadequate communication

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 Delayed
 Marginal discolouration
 Gingival recession
 Subpontic tissue shrinkage
 Porosity
 Wear

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Class Description

Class I Cause of failure is correctable without replacing restoration

Class II Cause of failure is correctable without replacing restoration,

however, supporting tooth structure requires repair.
Class III Failure requiring restoration replacement only.

Class IV Failure requiring restoration replacement in addition to repair or

reconstruction of supporting tooth structure.
Class V Severe failure with loss of supporting tooth. Fixed prosthodontics
replacement remains possible.
Class VI Severe failure with loss of supporting tooth. Conventional fixed
prosthodontics replacement is not possible.
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 Class I failure. A, Mandibular first molar metal ceramic crown lacking
occlusal contact. Crown replacement was not required since it was
possible to remove and improve existing crown. B, Crown in place with
improved occlusal contact.

 Class I failures are correctable through occlusal adjustment or composite

resin repairs without requiring replacement of the restoration.

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 Class II failure. A, Fracture involving endodontically treated lateral incisor restored
with complete crown. B, Acrylic resin post-and-core pattern custom made to fit
existing crown. C, Cast post and core cemented into remaining tooth structure. D,
Original crown cemented in place.
 In a Class II failure, the restoration itself is acceptable; however, the supporting
tooth structure or foundation (core restoration, or post and core) requires repair or
reconstruction.
 Examples of Class II failures are foundation failures and loss of supporting tooth
structure resulting from caries or fracture.Fractures can also occur during attempts
to remove a restoration.
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 Class III failure. A, Maxillary incisor complete all-ceramic crowns required
replacement because of gingival inflammation and patient dissatisfaction with
crown esthetics. Condition of supporting tooth preparations was satisfactory
without additional treatment. B, Replacement all-ceramic crowns with
improved gingival health and esthetics.

 Restoration replacement is required with a Class III failure; however, the

supporting tooth structure or foundation remains intact and would provide
acceptable support for a replacement restoration

 This classification would include unserviceable restorations due to defective

margins, technical failures, or esthetic considerations.

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 Class IV failure. A, Failed maxillary central incisor restorations requiring
replacement. B, Prepared teeth were carious and lacked sufficient support for
crown reconstruction. C, After periodontal health improvement, cast posts and
cores were fabricated and cemented in place. D, New metal ceramic crowns.
 In Class IV situations, the restoration requires replacement, and the
supporting tooth structure or foundation is deficient
 Failures associated with caries, fracture of supporting tooth structure, or a
defective foundation.
 Before making a new restoration, the tooth structure must be reinforced,
reconstructed, or replaced. Various means can be used, including cores and
post-and-core foundations

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 Class V failure. A, Restored maxillary right central incisor tooth was extracted
following periodontal complications. B, Subsequently, with adjacent teeth suitable
for abutment service, conventional FPD was fabricated to replace extracted incisor
tooth.
 In a Class V failure, support structures can no longer provide adequate
support for the existing restoration due to extensive fracture, carious
destruction, periodontal problems, or other complications.
 A damaged tooth may require extraction. Even though the failure may involve
tooth loss, restoration of the site with a conventional fixed prosthesis remains
a reasonable option when other available teeth can be incorporated into a
redesigned restoration
 Class V failures can also include FPDs for which abutment teeth provide
inadequate tooth and/or periodontal support

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 Class VI failure. Distal abutment for mandibular 3-unit FPD, compromised by
severe carious and large periapical lesion, was not restorable. Extraction resulted
in Class VI failure; conventional FPD replacement was no longer possible.

 A Class VI failure is the most severe failure.

 A conventional fixed replacement is no longer possible because of supporting tooth
failure and the lack of additional support for use in a redesigned restoration.
 An example of a Class VI FPD failure would be the loss of the terminal abutment of
an FPD replacing a first molar, assuming the third molar is missing or unsuitable for
abutment service

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Can be divided into:
 Tooth

 Patient

 Clinician / technician

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 Vital vs non-vital tooth
 There is higher frequency of fracture for
non-vital abutment tooth than vital
tooth. Noted that 75% of the abutment
tooth that fractured were endodontically
treated, had post and were terminal
abutment.

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 RCT with post and core
 The success rate of single crown with
underlying post was 92% whereas for
teeth without post was 94%. The
differences between these two group
was no statically significant.

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 Patients behaviors
 Patient’s compliant towards treatment.
 Patient motivation for outcome and
review after the placement of the
prosthesis.
 Habits:
Smoking-reduce success rate.
Bruxism-tend to make the prosthesis
fracture
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 Patient oral hygiene
 Successful long term of prosthesis
depend upon good oral hygiene.
 Patient must be educated and
motivated to maintain good oral
hygiene.
 Plaque accumulation around the
prosthesis can cause gingivitis – perio
disease and caries.
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 Clinician
 Experience
 Skill
Quality of the tooth prep (based on
the principle).
The accuracy of the secondary
impression.
The quality of the bonding.
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 Technician
 Failure in communication between
clinician and technician in term of
design, shape and shade of prosthesis.
 Clinician not provide enough
information to the technician and do not
discuss about the outcome of the
prosthesis.
 Lacks of experience and skill.
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