resin bonded bridges.modi/ labial orthodontics

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Resin Bonded Fixed Partial Denture –case reports.

INDIAN DENTAL ACADEMY

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Introduction

• The need for conservation of natural tooth structure has always been the desired but elusive goal in dentistry.

• In fixed partial prosthodontics this goal manifests itself with the continued interest and development of Resin bonded fixed partial dentures (RBFPD).


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Definition

• Resin bonded prosthesis

A prosthesis that is luted to tooth structure,primarily enamel,which has been etched to provide mechanical retention for the resin cement. -GPT-7

• Also called as Maryland bridges, Rochette bridges.


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Why a Re-Look ?

1. Sometimes Cost and other constraints make single teeth implants unfeasible.

2. Recent and further scope of Advances in adhesive dentistry.

3. Lesser failure rates of RBFPD’s found in recent studies.


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History and development

• Development of Acid etching of enamel by Buonocore.

• Bowen developed the BIS-GMA composite resins.


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Rochette bridge

• Developed in 1973.It was a complete innovation.Use of ring like retainers,with funnel shaped

perforations through them to enhance resin retention.

Silane coupling agent was used to produce adhesion to the metal.


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Maryland ridge

• Etched metal surface first developed by Livaditis and Thompson.

• Treatment of metal surface with acids and controlled electric current.


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Virginia bridge.

• Roughned surface of the retainer itself provides for retention

• Achieved by lost salt technique.

• Air abrasion with aluminium oxide.


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Advantages of Resin bonded bridges.

1) Reduced cost .

2) No anesthetic needed.

3) Supragingival margins.

4) Minimal tooth preparation.

5) Rebonding possible.


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Indications.

1) Adolescents with single missing teeth (traumatic or congenital).

2) Caries- free abutment teeth and good oral hygiene.

3) Maxillary incisor replacements (most favourble prognosis) and Mandibular incisor replacements.

4) Periodontal splints.

5) Single posterior tooth replacements.


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• Survival rates of FPD – 96% at 5 years – 74% at 15 years

• Creugers et al 1994.

• Survival rates of RBFPD– 74% at 4 years (meta study)– 93% at 11 years Barrack


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Tooth preparation The strength of bonding to prepared and

etched enamel is greater than that to etched but unprepared enamel.(Aker et al 1979)

Preparation should cover as large as area as esthetically possible


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Cervical margin should always be in enamel and Supragingival.

Preparation should ensure precise insertion and seating of the framework.

180 0 wraparound of the metal.


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Case-1

• History


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Examination

• Root exposure of central incisor and canine.

• Widened edentulous space mesiodistally.

• I mm over jet and overbite


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• Good oral hygiene and favorable periodontal status.

• Study models were made and articulated.

• Radiographs were taken.


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Treatment plan • Resin bonded fixed partial denture was

the treatment of choice1. As it kept the option of going for bone

grafting and implant a possibility.

2. Angulation of abutments and gingival recession made the possibility of 3 unit conventional FPD a difficult proposition.


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Tooth preparation

• Very conservative palatal preparation.

• Supragingival chamfer.

• Proximal groves.


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Laboratory procedure

• Wax pattern was made and casted in Ni-Cr alloy.

• Pontic was made in appropriate shade of ceramic.

• Holes were made on the wings to facilitate light curing of composite.


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Bonding steps.

• Sand blasting of metal framework.

• Acid etching

• Rinsing and drying.

• Contamination to be avoided at all cost.


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Case 2

• Missing mandibularRight central incisor


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• Bone loss and gingival recession in abutment teeth.

• Grade 1 mobility.


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Treatment plan.

• Resin bonded fixed partial denture was the treatment of choice.As patient wanted a fixed replacement of

the missing teeth.

Need for splinting the lower anteriors.


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Tooth preparation


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• Conventional Maryland bridge fabricated with porcelain fused to metal pontic.


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• Bonded with resin cement.


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Case 3• 16 year old

female patient.

• Traumatic loss of maxillary left central incisors .

• Using RPD for 3 years.


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• Ridge resorption.

• Widened pontic space.


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Treatment plan

Resin bonded bridge was the treatment of choice.

• Taking into consideration age of the patient.

• Need for the conservative treatment.


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Case –4 Metal free resin bonded bridge

• Loss due to trauma.

• Highly reduced pontic space.


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Treatment plan.

Metal free resin bonded bridge was the treatment of choice

• As patient had edge to edge bite - less unfavourable stresses transmitted to the prosthesis.

• Superior esthetics.


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Treatment plan• Proximal

slicing of the abutments was done to distribute the space evenly.

• Diagnostic wax up was shown to the patient


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Temporization


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Laboratory procedures• Hardcore porcelain fired on refractory cast.(Hi –

ceram) • Porcealin build up done on the coping .


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Disadvantages

• Irreversible.

• Uncertain longevity.

• No space correction.

• No alignment correction.

• Difficult temporization.


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Contraindications.

• Extensive caries.

• Nickel sensitivity.

• Deep vertical overbite.

• Extensive restoration on abutment teeth.

• Parafuncitonal habits


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Conclusion

• Rapid development in adhesive technology holds a promising future for RBFPDs, which were originally developed as an interim restoration. Today high success rate and reducing cost is fast making RBFPD’s as a treatment alternative for permanent oral rehabilitation.


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• Furthermore in a developing country like India this esthetic approach, which is cost effective too, holds promising future.


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resin bonded bridges.modi/ labial orthodontics

Education

development of resin

resin retention

etched enamel

resin cement

minimal tooth preparation

adv of resin bonded

unprepared enamel

bonded prosthesis