A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years.

OBJECTIVES: The objective of this systematic review was to assess the 5-year and 10-year survival of resin-bonded fixed dental prostheses (RBBs) and to describe the incidence of technical and biological complications. MATERIALS AND METHODS: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on RBBs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction were performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5- and 10-year proportions. RESULTS: The search provided 367 titles and 87 abstracts. Full-text analysis was performed for 22 articles resulting in seven studies that met the inclusion criteria. Five articles were found through manual search, and 17 studies were provided from (Pjetursson et al. 2008, Clinical Oral Implants Research, 19, 131), resulting in an overall number of included studies of 29. Meta-analysis of these studies reporting on 2300 RBBs indicated an estimated survival of resin-bonded bridges of 91.4% (95 percent confidence interval [95% CI]: 86.7-94.4%) after 5 years and 82.9% (95% CI: 73.2-89.3%) after 10 years. A significantly higher survival rate was reported for RBBs with zirconia framework compared with RBBs from other materials. RBBs with one retainer had a significantly higher survival rate (P < 0.0001) and a lower de-bonding rate (P = 0.001) compared with RBBs retained by two or more retainers. Moreover, the survival rate was higher for RBBs inserted in the anterior area of the oral cavity compared with posterior RBBs. The most frequent complications were de-bonding (loss of retention), which occurred in 15% (95% CI: 10.9-20.6%) and chipping of the veneering material that was reported for 4.1% (95% CI: 1.8-9.5%) of the RBBs over an observation period of 5 years. CONCLUSION: Despite the high survival rate of RBBs after 5 and 10 years, technical complications like de-bonding and minor chipping were frequent. RBBs with zirconia framework and RBBs with one retainer tooth showed the highest survival rate.

Survival of cast-metal, resin-bonded fixed partial dental prostheses after nearly 20-year follow-up: A retrospective study.

STATEMENT OF PROBLEM: Cast-metal resin-bonded fixed partial dental prostheses (RBFPDPs) are a conservative approach to replacing missing teeth. Despite their recognized advantages, the use of cast-metal RBFPDPs as a definitive option remains somewhat controversial because of the lack of long-term studies on their success. PURPOSE: The purpose of this retrospective study was to evaluate the long-term survival rate of cast-metal RBFPDPs and investigate the influence of covariates such as sex, type of prosthesis, location, number of pontics, abutments, and type of luting cement on the survival of bonded prostheses. MATERIAL AND METHODS: This study evaluated 209 cast-metal RBFPDPs cemented in 181 patients (mean 41.06 ±11.90 years of age) treated in the principal author's private practice between July 1993 and May 2012. Data sheets were completed at the patients' recall examination at regular intervals or if seen for complications. Kaplan-Meier analysis was used to evaluate the survival rate of the prostheses before debonding. The Cox model and Wald test were used to analyze the prognostic factors (α=.05). RESULTS: A total of 198 prostheses were studied. Eleven cast-metal RBFPDPs were lost to follow-up. This study evaluated the effect of different variables on the survival rate of both conventional RBFPDPs (wing-wing) and combination resin-bonded FPDPs (wing-crown) types. Survival rate was divided into "with repair" and "without repair" groups. The mean survival time was 102.24 months for the group with no repair and 119.76 months for the group with repair. The survival rate after 5, 10, and 15 years was 86%, 42%, and 15% with repair, whereas 69%, 32%, and 14% of the prostheses survived without repair. CONCLUSIONS: In appropriate clinical conditions and selected patients, cast-metal RBFPDPs were a viable treatment option with an acceptable survival rate.

Impact of complications of single tooth restorations on oral health-related quality of life.

OBJECTIVE: To compare oral health-related quality of life (OHRQoL) among subjects who received implant-supported crowns (ISC) and 2-unit cantilevered resin-bonded bridges (cRBB) in a bounded single tooth space (BSTS) after at least 5 years and to investigate factors associated with their OHRQoL. METHODS: A case-control study among 78 subjects who received ISC or cRBB rehabilitation at a teaching hospital (39 ISCs and 39 cRBBs). OHRQoL was measured using the Oral Health Impact Profile (OHIP-49) and compared between treatment modality. Variations in OHIP scores with respect to "minor complications" (repair of the original "survived" restorations) and "major complications" (replacement of "failed" restorations); and number of complications were determined in bivariate and multivariate analyses (negative binominal regression) controlling for socio-demographic and clinical factors. RESULTS: Oral Health Impact Profile scores were similar among those who received ISC and cRBB (P = 0.53). Among subjects with complicated restorations, those with major complications reported significantly higher OHIP scores (poorer OHRQoL) than those with minor complications (P = 0.02). Subjects who experienced multiple complications had significantly higher OHIP scores (poorer OHRQoL) than those with a single complication (P = 0.04). In regression analyses (which considered OHIP scores of those with complications), the nature of complications (P < 0.01), treatment modality (P = 0.04), and gender (P = 0.02) emerged as significant factors. CONCLUSION: In the rehabilitation of a BSTS patients, OHRQoL was similar irrespective of treatment modality (ISC or cRBB). Among those who experienced complications their OHRQoL was associated with the nature of complications, treatment modality and gender.

Implant-supported fixed cantilever prosthesis in partially edentulous jaws: a cohort prospective study.

BACKGROUND: Reconstructive procedures present a higher rate of biological costs due to the necessity of bone harvest and grafts, use of semipermeable barriers etc. On the hand, implant supported cantilever prostheses could allow a simpler rehabilitation procedure. AIMS: The aim of the present study was to assess the clinical outcome of patients treated with implant-supported fixed partial dentures (FPD) with cantilever after a mean follow-up time of 8 years. MATERIAL AND METHODS: The study included 45 consecutive partially edentulous patients treated between January 1994 and August 2006 with 59 partial cantilever fixed prostheses supported by 116 ITI implants. The primary outcome variable considered was the presence of complications at the subject and bridge level; the secondary outcome variable was marginal bone loss (MBL). The frequency of complications was analyzed according to cantilever location and opposite dentition and tested by Fisher's exact test. A multilevel regression model was constructed to analyze the factors influencing MBL with three levels: subject as the highest, and then implant and site. During the follow-up period, 11 implants showed a bone loss exceeding the limit for success, out of which two implants showed an infection of the peri-implant tissue. RESULTS: After an average observation of 8.2 years of cantilever prostheses loading, the implant success and survival rates were 90.5% and 100%, respectively. Besides, the prosthetic success and survival rate were 57.7% and 100%, respectively. DISCUSSION: None of the predictors included in the multilevel model presented a significant impact on the bone loss between baseline and the follow-up examination. CONCLUSIONS: The authors concluded that the prognosis of implant-supported FPDs and marginal bone loss at implants were not influenced by the position or the length of the cantilever, the location of the bridge and type of opposite dentition. Implant-supported fixed cantilever prosthesis can be considered a suitable treatment choice.

[Efficiency of fixed partial dentures]. / Doelmatigheid van bruggen.

A proposal for restorative treatment is based on the expected efficiency of the treatment. Efficiency is determined by measuring the investment, such as the monetary and biological cost, against what is gained, such as functional restoration and durability. If one's goal is to save tooth tissue in the restorative process, it is interesting to compare the conventional fixed partial denture with the adhesive fixed partial denture. The mean survival rate of conventional fixed partial dentures clearly exceeds the mean survival rate of adhesive fixed partial dentures but there are biological risks. Loss of vitality of the abutment teeth and the occurrence of caries are more prominent with conventional fixed partial dentures than with adhesive fixed partial dentures. Consequently, the possibility of replacing a conventional fixed partial denture with a new conventional fixed partial denture is limited. Because this and other clinical aspects can not easily be expressed numerically, the patient should be informed qualitatively about the advantages, disadvantages and uncertainties of the various types of fixed partial dentures.

Clinical audit of posterior three-unit fixed-movable resin-bonded fixed partial dentures - A retrospective, preliminary clinical investigation.

BACKGROUND: Two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) have higher retention rates over longer span fixed-fixed RBFPDs. It has been hypothesized that interabutment stresses associated with fixed-fixed designs cause prosthesis debonds therefore for the replacement of molar-sized and longer spans, non-rigid connectors have been used to allow independent movement between two abutment teeth. OBJECTIVES: This preliminary study evaluates the clinical longevity and subjects' satisfaction of three-unit fixed-movable (FM3) RBFPDs provided at a dental teaching hospital. MATERIALS AND METHODS: Subjects who had received FM3 RBFPD(s) in the posterior region were clinically reviewed for complications. History of any debonds and subjects' satisfaction to the prosthesis was recorded. Time-to-debond (retention rate) and time-to-loss (survival rate) of these prostheses were presented in life tables. RESULTS: Ninety-eight prostheses in 84 subjects were examined. Their mean service life was 31.8 months (SD 11.5, range 3-67 months). Twenty-two prostheses had a history of debond, resulting in a retention proportion of 77.6%; seventeen of these were rebonded and still present at the time of review. One prosthesis was lost after extraction of a periodontally-involved abutment tooth, giving a survival proportion of 93.9%. High subject satisfaction and no adverse outcome were reported. CONCLUSION: Three-unit fixed-movable RBFPDs have a shorter success than two-unit cantilevered RBFPDs. However, non-rigid connectors allow the possibility of rebonding giving satisfactory short-term survival rate. Further research is needed to investigate their long-term efficacy. CLINICAL SIGNIFICANCE: Three-unit fixed-movable RBFPDs incorporating non-rigid connectors may be a feasible option for replacement of molar-size pontic in the posterior region.

10-year periodontal response to resin bonded bridges.

The purpose of this study was to evaluate the long-term (10 years +/- 15 months) periodontal response to resin bonded bridges (RBRs). A total of 103 patients who had RBRs bonded between 1980 and 1984 were recalled. Periodontal evaluations were made by two clinicians for all abutment teeth and for selected control teeth with intact, non-restored lingual surfaces. Periodontal indices consisted of: plaque index (PI), gingival index (GI), gingival recession, probing depth, and loss of attachment. Paired t tests indicated no significant difference in overall GI between experimental and control sites, but a significant difference in PI and probing depth with experimental sites (abutment teeth) showing higher PI and greater probing depths. Significant differences were found in overall recession and attachment loss, again with more recession and attachment loss observed on the abutment teeth as compared to the controls. Site specific analyses for PI, probing, and loss of attachment showed small but significant differences between experimental and control teeth in 15 of 21 sites. Although these findings may be statistically significant, the clinical impact for resin bonded restorations functioning for over 10 years is minimal and is comparable to periodontal response to other types of restorations.

Periodontal response to cantilevered and fixed-fixed resin bonded bridges.

The periodontal response to two types of resin bonded bridges was investigated. Cantilever or fixed-fixed resin bonded bridges which had been in service for at least two years were reviewed. Periodontal indices (plaque index, gingival index, bleeding index and pocket depth) were recorded for each bridge abutment and for matched contralateral teeth. There was no difference in the periodontal condition of the abutment teeth between cantilever and fixed-fixed resin bonded bridges, after they had been in service for at least two years. There was evidence of greater plaque accumulation and higher gingivitis levels affecting abutment teeth for both types of bridges compared with control teeth.

Sublingual ulceration associated with cementation of adhesive bridges.

The use of adhesive bridges is becoming more popular as designs are refined and more effective agents are developed for cementation. However, the fitting of such bridges is very technique-sensitive; an ill-fitting bridge will cause discomfort and difficulty with oral hygiene. It is important that practitioners take the problems illustrated in this case report into account when fitting adhesive bridges.

[Permanent adhesive dentures]. / Nes"emnye adgezivnye protezy.

The longitudinal clinical study (up to 15 years of clinical performance) was carried out to evaluate the efficiency of the different resin-bonded prostheses - fixed partial dentures, veneers, splints.

'A bridge too far'--the negative impact of a bridge prosthesis on gingival health and its conservative management.

Bridges are commonly used to replace missing teeth. Periodontal health may, however, be compromised by ill-fitting margins and excess cement. This case report describes the conservative management of chronic gingival inflammation adjacent to the resin-bonded retainers of an anterior bridge by gingival remodelling via a removable prosthesis. This avoided the need for surgical intervention and re-established a suitable gingival profile before placement of a definitive cantilever resin-bonded bridge.

Orofacial reaction to methacrylates in dental materials: a clinical report.

This clinical report presents an unusual response of acute gingivostomatitis caused by contact sensitivity to the methacrylate compounds present in a dental restorative material.

Resin-bonded fixed partial dentures. I. Proposed standardized criteria for evaluation.

Since etched cast resin-bonded prostheses were introduced in 1980, many articles have been written about them. Most state that the reported clinical success of these bonded restorations has been based primarily on the longevity of the bonding. For a comprehensive evaluation, however, it is important not only to examine the bonding but also to evaluate the periodontal response. The proposed standard method provides a consistent and comprehensive evaluation of resin-bonded prostheses that is applicable for researchers and clinicians alike.

Resin-bonded fixed partial dentures. II. Clinical findings related to prosthodontic characteristics after approximately 10 years.

A clinical study was conducted for patients who were functioning with resin-bonded fixed partial dentures for approximately 10 years. The purpose of this study was to evaluate the periodontal health and determine the prosthodontic characteristics of the fixed partial dentures. Results indicated that plaque indexes, probing, recession, and loss of attachment were greater for abutments than for control teeth. The differences were statistically significant but clinically small. The bonded restorations were generally well adapted and contoured for case of cleaning.

Acid-etched, resin bonded cast metal prostheses: a retrospective study of 5- to 15-year-old restorations.

Eighty-five resin bonded prostheses were evaluated in a retrospective study over a 15-year period. All had been in function for at least 4.5 years. Multifactorial variables were studied to ascertain their effect on debonding and the health of the oral tissues. The results showed: (1) the caries rate of the retainer teeth was 6%, (2) the mean gingival indices for the prostheses were significantly higher (P > .0001) than those of the remaining dentition, (3) 61% of the restorations had not debonded (if failure resulting from trauma was not included, the incidence of debonding dropped to 19%), and (4) all patients liked their prostheses.

Resin-bonded inlay retainer prostheses for posterior teeth. A 5-year clinical study.

This study evaluated posterior resin-bonded prostheses using inlays as retainers. Thirty-nine patients missing at least one premolar or first molar received 51 resin-bonded fixed partial dentures with high noble alloy inlay retainers and a metal ceramic pontic. Resin luting material bonding to the framework was secured by the Silicoating method (24 fixed partial dentures), lost sugar crystal method (13 fixed partial dentures), or tin plating (14 fixed partial dentures). Clinical examinations were performed 1 week, 1 month, 6 months, 1 year, 2 years, and 5 years after cementation. None of the fixed partial dentures with silicoating or sugar crystal impressions lost retention, whereas two of the tin-plated fixed partial dentures required replacement. Resin-bonded inlay-retained prostheses appear to be a favorable alternative to other types of fixed partial dentures.

Clinical complications in fixed prosthodontics.

The purpose of this article is to identify the incidence of complications and the most common complications associated with single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores. A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. The searches focused on publications that contained clinical data regarding success/failure/complications. Within each type of prosthesis, raw data were combined from multiple studies and mean values calculated to determine what trends were noted in the studies. The lowest incidence of clinical complications was associated with all-ceramic crowns (8%). Posts and cores (10%) and conventional single crowns (11%) had comparable clinical complications incidences. Resin-bonded prostheses (26%) and conventional fixed partial dentures (27%) were found to have comparable clinical complications incidences. The 3 most common complications encountered with all-ceramic crowns were crown fracture (7%), loss of retention (2%), and need for endodontic treatment (1%). The 3 most common complications associated with posts and cores were post loosening (5%), root fracture (3%), and caries (2%). With single crowns, the 3 most common complications were need for endodontic treatment (3%), porcelain veneer fracture (3%), and loss of retention (2%). When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%).