The cantilever contact-point resin bonded bridge; adhesion 2.0.

AIM: When young patients are congenitally missing anterior teeth, different treatment modalities can be used to complement the dental arch. This article proposes a new treatment modality for the replacement of anterior teeth, the cantilever contact-point resin bonded bridge (CCP-RBB). MATERIALS AND METHODS: In this proof of principle study, CCP-RBB's delivered by one operator were clinically assessed. Patients who were missing maxillary incisors and had suitable intra-oral conditions for a contact-point cantilever RBB were included. Three cases are presented to describe all adhesive steps. This proof of principle clinical study is presented with up to 60 months follow-up of the cantilever contact resin bonded bridges. RESULTS: A total of 19 CCP-RBB's were evaluated after a mean period of 29.8 months. None of the restorations exhibited failure, carious lesions or fractures during the follow-up periods, demonstrating an absence of restoration debonding or the need for repair. CONCLUSION: The new cantilever contact-point resin bonded bridge exhibited an excellent treatment modality without failure or debonding up to 5 years. More and extended duration in vivo studies are needed to evaluate this new treatment modality. CLINICAL SIGNIFICANCE: In this proof of principle the new cantilever contact-point resin bonded bridge obtained excellent results up to 5 years of clinical follow-up.

Fracture strength of anterior cantilever resin-bonded fixed partial dentures fabricated from high translucency zirconia with different intaglio surface treatments.

PURPOSE: To compare the fracture resistance and failure modes of anterior cantilever resin-bonded fixed partial dentures (RBFPDs) fabricated from high translucency zirconia with different intaglio surface treatments. MATERIALS AND METHODS: Sound-extracted canines (N = 50) were randomly divided into five groups (n = 10) to be restored with high translucency zirconia RBFBDs of different intaglio surface treatments. The RBFPD was designed using exocad software and fabricated using a CAM milling machine. The RBFPDs were treated differently: abrasion with 50 µm alumina particles (Group 1); abrasion with 30 µm silica-coated alumina particles (Group 2); abrasion with silica-coated alumina particles (30 µm) and silane application (Group 3); abrasion with silica-coated alumina particles (30 µm) and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer application (Group 4); abrasion with silica-coated alumina particles (30 µm) and silane, and 10-MDP primer application. All RBFPDs were cemented using dual-cured resin cement. The RBFPDs underwent 6000 thermal cycles with distilled water at 5/55°C for 2 min per cycle and then mechanical cyclic loading with 1200,000 cycles of 50 N at a 1.7 Hz frequency at an angle of 135° to the abutment's long axis. Then, RBFPDs were loaded to fracture using a universal testing machine at 1 mm/min. Maximum fracture forces and failure modes were recorded. Fractured specimens and uncemented specimens were examined using a scanning electron microscope. Data was analyzed using ANOVA and Games-Howell post hoc tests at p < 0.05. RESULTS: Mean fracture load results showed a statistically significant difference between the research groups (p < 0.0001) and it ranged from 69.78 to 584 N. Group 4 exhibited the highest fracture load mean (p < 0.0001) which was significantly different from all other groups. Group 2 recorded a significantly higher fracture load mean than Group 3 (p = 0.029). Three modes of failure were observed: prosthesis debonding, prosthesis fracture, and abutment fracture. CONCLUSIONS: Abrasion of zirconia surface with 30 µm silica-coated alumina particles and application of 10-MDP primer yielded the highest mean fracture loads of monolithic high translucency zirconia RBFPD. The mode of fracture of the RBFPDs was influenced by the type of surface treatments.

Effect of different designs of minimally invasive cantilever resin-bonded fixed dental prostheses replacing mandibular premolar: Long-term fracture load and 3D finite element analysis.

PURPOSE: To evaluate the fracture load and stress magnitude of different retainer designs of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging. MATERIALS AND METHODS: Fifty caries-free human mandibular molars were prepared as abutments for cantilever fixed dental prostheses using different retainer designs: one wing (OW), two wings (TW), inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC). Computer-aided design and computer-aided manufacturing were used for milling the RBFDPs using fiber-reinforced composite (FRC), and the restorations were adhesively bonded. The specimens were then subjected to thermomechanical aging and loaded until failure. The 3D finite element analysis (FEA) was performed with five models of retainer designs similar to the in vitro test. Modified von Mises stress values on enamel, dentine, luting resin, and restorations were examined. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (p < 0.001). RESULTS: A statistically significant difference (p < 0.001) was found between all groups except between IR and LC and between OW and TW designs, with the highest mean failure load detected for OC (534.70 N) and the lowest detected for OW (129.80 N). With regard to failure mode, OW, TW, and LC showed more incidences of favorable failure patterns than IR and OC designs. FEA showed that FRC transmitted low stresses in tooth structure and high stresses to the luting resin. CONCLUSIONS: LC and OC designs can be used to design cantilever RBFDPs in premolar area. IR design transmitted more stresses to the tooth structure and resulted in 30% catastrophic failure. OW and TW were below the normal occlusal force and should be carefully used.

CAD/CAM single-retainer monolithic zirconia ceramic resin-bonded fixed partial dentures bonded with two different resin cements: Up to 40 months clinical results of a randomized-controlled pilot study.

PURPOSE: This pilot study was part of a larger study planned for the future which aimed to compare the clinical success of two different resin cements used in the cementation of CAD/CAM single-retainer monolithic zirconia ceramic resin-bonded fixed dentures (RBFPDs). METHODS: Twenty-four RBFPDs were fabricated with monolithic zirconia (Katana™ Zirconia HT, Kuraray Noritake Dental Inc, Tokyo, Japan). Panavia F2.0 (PF2.0; n = 12) and Panavia V5 (PV5; n = 12) were used for cementation. The survival period was defined as the time when the restoration was placed in the mouth and lasted until an irreparable damage occurred. The repairable failures were identified as relative and irreparable failures were identified as absolute failure. The survival rate of the RBFPDs was determined by the Kaplan-Meier estimator. Statistical significance was set at p < 0.05. RESULTS: The mean observation times of the PF2.0 group and the PV5 group were 40.45 ± 6.15 months and 40.18 ± 6.41 months, respectively. Four failures occurred in the PF2.0 group. No failure was observed in the PV5 group. The curves of survival rate (PF2.0 = 80%, PV5 = 100%) showed no statistically significant difference (p = 0.031), although success rate (PF2.0 = 66.7%, PV5 = 100%) showed statistically significant difference (p = 0.317). CONCLUSION: Up to 40 months mean follow-up period, performance of RBFPDs bonded with PV5 was better than with PF2.0. CLINICAL SIGNIFICANCE: For clinicians, it is a matter of hesitation to apply single-retainer RBFPDs. This study contains results of 40 months (minimum 32, maximum 50.47 months) clinical follow-ups of single-retainer RBFPDs. These results will enlighten clinicians about the clinical success of the resin cement type for single-retainer monolithic zirconia ceramic RBFPDs.

Clinical performance of a modified Resin-Bonded fixed partial denture (Carolina bridge): A retrospective study.

OBJECTIVES: This research aims to retrospectively evaluate the clinical performance of Carolina bridge (CB) placed at a dental school. MATERIALS AND METHODS: Data were collected from the electronic patient record system. A follow-up letter was sent to the subjects' mailing address explaining the research purpose along with a questionnaire to assess their satisfaction with the treatment. A phone interview was performed to assess patient satisfaction, function, and choice of permanent restoration. Finally, a clinical exam was conducted for patients that agreed to come for a follow-up and still had their CBs. RESULTS: Twenty-three patients with 26 resin-bonded CBs met the inclusion criteria. All patients who did the phone interview reported to be very satisfied with the treatment. Most chose to keep the CB as definitive treatment and not to move forward with implant therapy. According to the number of rebonding needed to maintain the CB, the types of survival were analyzed as 42.3% complete survival (no rebonding needed), 26.9% functional survival (rebonded once), 23.1% survival with multiple rebondings, 7.6% failure. CONCLUSION: The performance of CBs revealed highly acceptable performance with high-patient satisfaction. CLINICAL SIGNIFICANCE: Carolina ridge is an esthetic and conservative interim treatment option that can be utilized in favorable clinical situations.

Secure and precise insertion of minimally invasive resin-bonded fixed dental prostheses after ridge augmentation by means of a positioning splint.

OBJECTIVE: Single-retainer resin-bonded fixed dental prostheses (RBFDPs) are described as an excellent minimally invasive treatment modality for the replacement of a single missing incisor even in cases of congenitally missing teeth that are often associated with hard and soft tissue defects that need to be properly managed to optimize the esthetic outcome. The lack of a retentive form due to the minimally invasive preparation form makes the adhesive bonding procedure for RBFDPs relatively technique-sensitive and might discourage practitioners from offering this treatment modality. CLINICAL CONSIDERATIONS: A patient with both maxillary lateral incisors congenitally missing was assessed for eligibility for treatment with RBFDPs. Bilateral horizontal ridge defects were present and treated through ridge augmentation to ensure an ovate pontic design and enhance the esthetic outcome. A minimally invasive preparation within enamel was conducted; the restorations were digitally designed and milled out of (3Y-TZP) zirconia ceramic with labial veneering with feldspathic ceramic for enhanced esthetics. An improved design of positioning splints was used for the adhesive bonding procedure to ensure exact, secure, and flawless insertion of the restorations. CONCLUSIONS: RBFDPs offer a highly esthetic treatment modality for missing teeth in the anterior area. Tissue defects could be overcome be means of a minor oral surgery, while using improved positioning splints might ensure flawless adhesive bonding and promote the usage of RBFDPs. CLINICAL SIGNIFICANCE: Hard and soft tissue defects can be remarkably optimized through a minor ridge augmentation. Improved positioning splints allow an easy and secure positioning as well as visual inspection of the seating in end-position and complete removal of resin cement excess. Implementing the concept of insertion splints might promote RBFDPs for anterior tooth replacement as it helps preventing bonding errors.

Clinical Performance of Posterior Inlay-Retained and Wing-Retained Monolithic Zirconia Resin-Bonded Fixed Partial Dentures: Stage One Results of a Randomized Controlled Trial.

PURPOSE: To prospectively compare the clinical performance of posterior inlay-retained and wing-retained monolithic zirconia fixed partial dentures (FPDs). MATERIALS AND METHODS: After simple randomization, 30 participants received either one inlay-retained (n = 15; mean age: 56.38 ± 12.70 years; 10 men [66.7%]) or one wing-retained (n = 15; mean age: 45.90 ±13.24 years; 7 men [46.7%]) FPD. The restorations, which predominantly replaced first molars, were fabricated from translucent, 3 mol% yttria-stabilized zirconia and attached with self-etching resin cement. Restorations and abutment teeth were clinically followed up for complications one week and 3, 6, and 12 months after cementation. Plaque and gingival scores, probing pocket depths, and attachment levels were recorded for the abutment and contralateral reference teeth both before treatment and during follow-up examinations. The restorations were also assessed in accordance with FDI World Dental Federation criteria. Statistical analyses were conducted with R (α = 0.05). An adaptive, 2-stage study design based on the incidence of failure-free survival in the groups after 12 months (stage 1) was implemented. Predefined decision rules were used to determine whether further recruitment (stage 2) would enable the detection of a statistically significant difference between the restoration designs with sufficient power. RESULTS: During 12 months, only one wing retainer debonded which required removal of the FPD. Failure-free survival was thus 93.3% for wing-retained and 100% for inlay-retained FPDs (log-rank test, p = 0.317). Moderate aftercare resulted in intervention-free rates of 78.8% and 86.7% for inlay-retained and wing-retained restorations, respectively (log-rank test, p = 0.605). Based on FDI World Dental Federation criteria, all restorations were acceptable at the 12-month follow-up (Fisher-Boschloo test, p = 0.161). Plaque, gingival, and periodontal scores remained practically unchanged from before treatment to the 12-month follow-up. Recruitment was stopped after stage 1 because, based on the small difference in the incidence of failure-free survival in the groups, it was accepted that it would not be possible to recruit the necessary number of participants to show a statistically significant difference between the retainer designs. CONCLUSIONS: Both inlay-retained and wing-retained monolithic zirconia resin-bonded FPDs performed well for the 12-month, short-term follow-up period.

Influence of the preparation form on the retention of resin-bonded attachments for removable dental prostheses.

OBJECTIVES: The study evaluated the influence of the number of retention grooves and the retainer wing thickness on the retention of resin-bonded attachments (RBAs). METHODS: Overall, 64 extracted human teeth were prepared, whereby the number of retention grooves (4, 2, 1, or no grooves) and the material thickness (0.7 or 0.5 mm) of the RBAs were varied. This resulted in eight groups with eight specimens each. A sample size of eight specimens per group was chosen because the chewing simulator used for dynamic loading can load eight specimens at a time. After the size of the adhesive area was determined, the abutment teeth were provided with RBAs and subjected to a dynamic loading with thermal cycling. Finally, the failure load was examined using a retention test. RESULTS: The mean failure loads ranged from 152 ± 50 N to 228 ± 32 N. There had been a significant interaction between the two main factors, i.e., number of retention grooves and material thickness. Neither the number of retention grooves nor the size of the adhesive area had a significant influence on the failure load. CONCLUSIONS: Using a reduced number of retention grooves seems reasonable. However, clinical considerations suggest using two retention grooves to simplify the preparation and bonding procedures. CLINICAL RELEVANCE: The retention of resin-bonded attachments is promising and supports the clinical application of this minimally invasive treatment modality.

Glass-ceramic resin-bonded fixed partial dentures for replacing a single premolar tooth: A prospective investigation with a 4-year follow-up.

STATEMENT OF PROBLEM: Resin-bonded fixed partial dentures (RBFPDs) are a reliable treatment option for the replacement of a single missing tooth. Glass-ceramic may be a promising material for the fabrication of RBFPDs, but clinical verification has been lacking. PURPOSE: The purpose of this prospective clinical study was to evaluate the outcomes of glass-ceramic RBFPDs on participants with a single missing premolar. MATERIAL AND METHODS: Twenty participants (6 men, 14 women; age range: 20 to 54 years) were treated with 2-retainer RBFPDs. These RBFPDs were made of lithium disilicate glass-ceramic (IPS e.max Press; Ivoclar Vivadent AG) and designed with improved C-shaped retention. These prostheses were evaluated at 6 months, 12 months, and annually thereafter and were classified as survival or failure. Analysis was performed with the Kaplan-Meier analysis (95% confidence interval). Modified United States Public Health Service (USPHS) criteria were used to rate the clinical performance. Parameters assessed were fracture, marginal integrity, marginal discoloration, color of restoration, secondary caries, and abutment mobility. RESULTS: Twenty RBFPDs were provided, 9 in the maxilla and 11 in the mandible. The mean observation time was 49.2 months (minimum 9 months, maximum 53 months). Nineteen RBFPDs were evaluated as having survived during the observation period with some acceptable marginal discoloration, 1 RBFPD had to be replaced because of fracture and secondary caries and was evaluated as a failure. The Kaplan-Meier analysis revealed a survival rate of 95% after a 4-year observation. CONCLUSIONS: The glass-ceramic RBFPDs in this study displayed a good survival rate and clinical performance, indicating that glass-ceramic RBFPDs might be a promising approach for the short-term replacement of a single premolar. However, further investigations are needed to determine the long-term outcome.

The Maryland bridge retainer: A modification of a Maryland bridge.

Preservation of the maxillary lateral incisor space after orthodontic treatment in an adolescent patient traditionally requires the use of a retainer with a lateral pontic, commonly referred to as a "flipper," which is minimally effective in the long term. This article illustrates a technique for chairside fabrication of a Maryland bridge retainer for semi-permanent retention. A stainless steel braided palatal wire is bonded to the anterior teeth. A pontic is then built intraorally with flowable composite, using the palatal wire as scaffolding. The retainer is maintained until the patient is of age for a more permanent restoration.

Replacement of a missing molar despite proximal undercuts by using two single-retainer resin-bonded fixed dental prostheses.

AIM: The aim of this case report is to present the minimally invasive replacement of a missing molar in the presence of considerable proximal undercuts of the adjacent abutment teeth. The use of two single-retainer resin-bonded fixed dental prostheses (RBFDPs) made this therapy possible. MATERIALS AND METHODS: A missing mandibular right first molar required replacement. Two single-retainer RBFDPs were digitally designed in the shape of half a molar each and were milled using CAD/CAM from monolithic 3Y-TZP zirconia ceramic. The posterior RBFDP portion retained by the second molar was designed in the pontic contact area to create a common path of insertion for the anterior RBFDP portion with the distal surface of the second premolar. A slight interlocking between the proximal contact surfaces of the two pontics was designed to prevent future migration between the split restorations. Precise placement of the two RBFDPs during adhesive luting was ensured with the aid of a positioning splint. RESULTS: The patient was recalled after 10 months and was very satisfied with the minimally invasive molar replacement. CONCLUSION: Using two single-retainer RBFDPs to replace a molar in a split design enables a minimally invasive posterior tooth replacement despite considerable proximal undercuts of the adjacent abutment teeth.

[STUDY OF STRESS-STRAIN STATES OF RESIN-BONDED BRIDGES WITH DIFFERENT FRAMEWORKS DESIGN].

OBJECTIVE: To substantiate the optimal variant of the reinforcement of resin-bonded bridges (RBB) for replacing small included defects of the dentition in the lateral area by studying the stress-strain states (SSS) of their various designs. To study the stress-strain state, the RBB structures were simulated in the ANSYS 12.1 computer environment. In simulation model I, two fiberglass tapes were used to reinforce the RBB, in model II - two fiberglass beams, and in model III - a fiberglass tape and a beam. Maximum displacements, distribution of von Mises equivalent stresses and safety factors in RBB constituent elements were evaluated. The largest values ​​of the maximum displacement were established under the influence of angular load in photocomposite of artificial tooth in all models. Von Mises equivalent stresses formed concentrations in frameworks of models I and II places that could destroy RBB, in model III they were evenly distributed over tape and beam. The safety factor for photocomposite was 1.6 to 3.8, for tapes and beams - from 8.0 to 11.4 and from 38.5 to 87.4, respectively. The stress-strain states of RBB models differ significantly depending on their reinforcement, place and direction of load application. Reinforcement of RBB with tape and beam seems to be the best option, since in such RBB loads are more evenly distributed.

[CLINICAL STUDY OF THE STATE OF RESIN-BONDED FIXED PARTIAL DENTURES IN INDIVIDUALS WITH HIGH TEETH ABRASION].

The object of the paper is a clinical assessment of the resin-bonded fixed partial dentures (RBFPD) produced by the indirect method of dental composite resin materials with various reinforcement, in patients with I degree high teeth abrasion. 80 persons with I degree high teeth abrasion and small defects in the lateral part of dental arch with a length of not more than one tooth were examined. For patients of I group, 40 RBFPDs were made of nano dental composite resin and three glass fiber tapes laid horizontally; for patients of II group, 40 RBFPDs made of hardened nano dental composite resin were reinforced with the same tapes laid by the developed method. In 12 months, fractures and fixation disorders of 9 dentures were found in patients from I group (22.5% of the initial quantity), and patients of II group had fixation disorders in 2 dentures (5.0%), and 7 (17.5%) and 32 dentures (80.0%), respectively, had no significant and insignificant disorders. In 24 months, the patients of I group had fractures and fixation disorders of another 7 dentures (22.6% of the number of RBFPDs at a given time), and patients from II group had such disorders in 3 RBFPDs (7.9%), while 3 dentures (7.5% of the initial amount) and 22 RBFPDs (55.0%), respectively, had no disorders. In order to restore the dental integrity with small bounded edentulous teeth in patients with I degree high teeth abrasion, it is possible to use RBFPDs indirect production of which requires the application of hardened nano dental composite resin with reinforcement by means of three glass fiber tapes according to the developed method, which ensures restoration efficiency within 12 and 24 months at the level of 80.0% and 55.0%.

Five-year success rate of resin-bonded fixed partial dentures: A systematic review.

OBJECTIVES: To assess and compare the 5-year success rate of resin-bonded fixed partial dentures (RBFPDs) fabricated from different materials. METHODS: An electronic search on 3 databases from January 1965 to March of 2017 was done for human randomized clinical trials (RCTs), and prospective and retrospective cohort studies. The key words used in the search were: Bridge OR bridges OR fixed partial OR fixed dental AND resin bonded OR Maryland OR ceramic bonded. Quality assessment was done using the Newcastle-Ottawa scale. Success was defined as the RBFPDs remaining in situ and not having experienced debonding, biological failures, or mechanical failures at the examination visit. RESULTS: Meta analyses of the included studies showed an estimated 5-year success rate of 88.18% for the metal framework RBFPDs and 84.41% for the nonmetal framework RBFPDs. The estimated 5-year success rate for each nonmetal material category was 92.07% for zirconia, 94.26% for In-Ceram alumina, and 84.83% for fiber-reinforced composite. The failure rate was not statistically significant among the single, double, and multiple retainers RBFPDs (P > .05). Technical complications were the main reason for failures. CONCLUSION: The 5-year clinical performance of RBFPDs is similar to the performance of conventional fixed partial dentures (FPDs) and implant-supported crowns. CLINICAL SIGNIFICANCE: Clinicians should consider using RBFPDs more often because their clinical performance is similar to the performance of conventional FPDs and implant-supported crowns.

The Origin of the Maryland Bridge.

The dental world was introduced to a revolutionary and esthetically pleasing adhesive-retained fixed partial denture for the replacement of anterior missing teeth in the early 1980s.1, 2 Patient comfort was enhanced along with minimal pulpal trauma to adjacent teeth that may occur with the extensive cutting of tooth structure with the use of full coverage crowns. Proffered by faculty from the University of Maryland, this tooth replacement was ultimate known as the Maryland Bridge, and it has been used extensively to the benefit of many patients. However, as with anything in history, especially the history of dentistry, the evolution of these types of improvements often comes from information buried in the vaults of the numerous dental publications that arose in the 1700-1800s, vaults that are only too often never opened to the riches within. So it was also with this prosthetic replacement as significant evidence exists in 1887 that this prostheses was used routinely by restorative dentists.3 Dr. Allison R. Lawshee from Trenton, NJ, USA provided the dental world with this replacement prosthesis almost 100 years prior to the what we know today at the Maryland Bridge. While not possessing the properties of contemporary etching and adhesion, minimal tooth damage was highlighted and sound principles of cementation were advocated Figs. 1, 2 and 3. Historical evidence and enlightenment for today's generation at its finest.

Fixed, Fiber-Reinforced Resin Bridges on 5.0-mm Implants in Severely Atrophic Mandibles: Up to 5 Years' Follow-Up of a Prospective Cohort Study.

PURPOSE: The aim of this study was to evaluate the midterm outcomes of fixed, full-arch, fiber-reinforced resin bridges on ultrashort implants in terms of marginal bone loss and overall implant survival. PATIENTS AND METHODS: Patients with severely atrophic mandibles, corresponding to Cawood and Howell class V and class VI, were included in this prospective temporal cohort study. Mesial and distal peri-implant bone levels were measured on panoramic radiographs taken at the time of implant insertion (baseline) and at follow-up visits. RESULTS: A total of 17 patients with atrophic mandibular jaws with an average follow-up period of 2.9 ± 1.5 years were included. The cumulative 1-, 3-, and 5-year patient-based implant survival rates were 94.1%, and the cumulative implant survival rates were 98.5%. The marginal bone level (MBL) of the mesial implants was 0.0 ± 0.3 mm at the time of loading (n = 33), -0.1 ± 0.3 mm (n = 20) after 1 year, -0.4 ± 0.5 mm (n = 10) after 3 years, and -1.5 ± 1.0 mm (n = 4) after 5 years. The mesial bone level depended significantly on time and insertion depth. The MBL of the distal implants was -0.4 ± 0.4 mm (n = 34) at the time of implantation, -0.4 ± 0.6 mm (n = 20) after 1 year, -0.5 ± 0.5 mm (n = 10) after 3 years, and -2.2 ± 1.7 mm (n = 4) after 5 years. The distal bone level depended significantly on time and insertion depth. CONCLUSIONS: Fixed, full-arch, fiber-reinforced resin bridges retained by 4 ultrashort implants provide a comparatively cost-effective, safe, stable alternative for prosthetic restoration of the severely atrophic mandible. The overall implant survival rate and the MBL after 5 years are equivalent to those of threaded implants of conventional lengths.

Clinical procedures, designs, and survival rates of all-ceramic resin-bonded fixed dental prostheses in the anterior region: A systematic review.

OBJECTIVES: The aim of this study is to systematically review all the clinical articles about all-ceramic resin-bonded fixed dental prosthesis (RBFDP) in the anterior region and assess their designs, clinical procedures, and survival rates. A systematic review was conducted after searching electronic databases PubMed/Medline and EBSCOhost Research Databases for articles published in English between 1987 and July 2017. MATERIALS AND METHODS: The inclusion criteria were selected as all clinical studies, original design clinical reports, and clinical reports (follow-up time more than 1 year) as all clinical information in the literature are desired to be included in the present review. RESULTS: The initial electronic search generated 472 articles from PubMed/Medline and 464 articles from EBSCOhost Research Databases. After selection of the articles as per the inclusion criteria, a final sample of 29 original studies is decided as: 1 randomized controlled clinical trial, 4 clinical controlled trials, 4 prospective cohort studies, 2 retrospective cohort studies, 6 original design clinical reports, and 12 clinical reports. After evaluation of the selected articles, it is likely that cantilever design all-ceramic RBFDPs are more successful than two retainer design in the anterior region; however, there is limited evidence for this result in the literature. CONCLUSION: Well-designed randomized controlled clinical trials with large sample size are still needed to achieve more accurate results about the clinical success rate of different RBFDPs designs in the anterior region. CLINICAL SIGNIFICANCE: Indications, designs, abutment teeth preparation, provisionalization, try-in, surface treatment options, and cementation of the all-ceramic resin-bonded fixed dental prostheses are described in this article. Clinical survival rates are also given in detail, so that clinicians can easily compare the current studies and give their own decision about all-ceramic resin-bonded fixed dental prostheses in the anterior region.

A low cost minimally invasive adhesive alternative for maxillary central incisor replacement.

OBJECTIVE: The beneficial mechanical properties of zirconia, together with the adhesive techniques, provide a wide range of clinical applications, including the construction of thin structures and minimally invasive adhesive restorations. CLINICAL CONSIDERATIONS: A periodontal disease-related missing maxillary central incisor, in a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes treated with resin-bonded fixed partial denture using the missing tooth cemented to a zirconia framework and then bonded to the abutment teeth. CONCLUSIONS: According to the systemic conditions presented in this case report, using a low-cost technology and the missing tooth it was possible to obtain an easier and satisfactory esthetic and functional result. CLINICAL SIGNIFICANCE: The mechanical properties of zirconia made it possible to treat a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes with a thin zirconia framework and minimally invasive adhesive restorations.

In vitro comparison of the load-bearing capacity of ceramic and metal-ceramic resin-bonded fixed dental prostheses in the posterior region.

STATEMENT OF PROBLEM: The clinical use of ceramic resin-bonded fixed dental prostheses (RBFDPs) in the posterior region is desirable for esthetic and biological reasons but has been associated with many technical problems, including fractures or chipping of the veneer. Although these problems may be overcome by using monolithic zirconia, information is lacking about the load-bearing capacity of resin-bonded monolithic zirconia restorations for replacing a molar. PURPOSE: The purpose of this in vitro study was to compare the load-bearing capacity (Fu), the load at initial damage (F1d), and the failure pattern of posterior RBFDPs fabricated from monolithic zirconia (MZr), veneered zirconia (VZr), and veneered cobalt-chromium (VCo). MATERIAL AND METHODS: For the replacement of a maxillary first molar, 4 groups (n=8) of RBFDPs differing in prosthesis material and retainer design (MZr-IR-RBFDPs, VZr-IR-RBFDPs, MZr-WR-RBFDPs, and VCo-WR-RBFDPs; IR, inlay-retained; WR, adhesive wing-retained) were fabricated with anatomic congruence of the FDP-abutment complex. The RBFDPs were subjected to thermocycling (10000×6.5°C/60°C) and mastication simulation (30-degree oblique loading on the pontic; 1200000×108 N) and then loaded until failure in a universal testing machine (0.5 mm/minute). Test forces correlating with Fu and F1d were recorded. Statistical analysis was performed by using 2-way analysis of variance (ANOVA), 2-way repeated measures ANOVA, and the Tukey honest significant differences post hoc test (2-sided α=.05). RESULTS: Fu was significantly affected by retainer design (P<.001) and F1d by both retainer design (P<.001) and prosthesis material (P<.001). Fu was more than 2000 N for WR-RBFDPs and more than 1000 N for IR-RBFDPs (Tukey test ranking: MZr-WR-RBFDPs = VCo-WR-RBFDPs > MZr-IR-RBFDPs = VZr-IR-RBFDPs). Ceramic RBFDPs failed by complete fracture in the connector region, whereas failure of VCo-WR-RBFDPs was limited to the ceramic veneer. F1d was significantly lower (P≤.004) than Fu for veneered specimens only; F1d started at test forces below 500 N and coincided with veneer cracking. CONCLUSIONS: Load-bearing capacity suitable for the definitive restoration of a molar was observed for all groups. Veneered resin-bonded fixed dental prostheses, however, were susceptible to cracking of the veneer.