INTRODUCTION : It is important to be aware of obvious and subtle indications of prosthesis failure and to have a working knowledge of the procedures

that are necessary to remedy the situation. It is natural that dramatic mechanical failures, such as fracture attract attention, but it must be remembered that failures can also be esthetic and biologic in nature. Some failures are the result of poor patient care, while others occur as a result of defective design or inadequate execution of the clinical or laboratory procedures. Other failures like unacceptable colour match with age are normal because changes in the oral environment that are not related to prosthesis necessitate its removal and reconstruction. Also, a restoration may simply wear out. After all, prosthesis cannot routinely be expected to last a lifetime. BIOLOGIC FAILURES : 1) CARIES : Caries is one of the most common biologic failures, it may affect a bridge in several ways, either directly at the margins of the retainer, indirectly by starting elsewhere on the tooth and spreading to the fit surface of the castings or it may follow cementation failure. A study was conducted to evaluate the causes of failure and length of service of fixed restorations. They concluded that caries was the most common cause of failure and resin veneer metal crowns provided the longest services of all crown types observed (13.9 years) and failed most frequently because of worn or lost veneers. (Joanne N.W. et al 1998) Its detection can be very difficult particularly when complete coverage is used. At each appointment, the teeth should be thoroughly dried and visually inspected. Careful use must be made of explorer when assessing early enamel lesions because heavy-handed examination may damage the fragile
1

demineralized enamel matrix. Radiographs are also helpful, particularly interproximally. Conventional operative dentistry procedures can generally be used to restore small carious lesions without the need to fabricate a new prosthesis. Marginal caries can be restored by using amalgam, composite resin, or gold foil. Carious lesions in certain locations, such as proximal surfaces, may require removal of the prosthesis to obtain access to the caries. Extensive lesions may encroach on the pulp, making endodontic treatment necessary, or the tooth may be so much destroyed by caries that it cannot be restored and must be extracted. Meticulous oral hygiene must be a routine procedure for patients with a high caries index and particularly for those who have a past history of developing carious lesions around restorations. Other preventive measures should include the use of fluoride containing dentrifices, home mouth rinses containing fluoride and professionally applied topical fluoride. If the caries is secondary to cementation failure, then the bridge must always be removed and the sooner the better. 2) ROOT CARIES : Caries of exposed root surfaces can be a severe problem in the age group commonly seeking fixed prosthodontic care. Root surface caries seems to be initiated by a plaque of different composition containing more anaerobic and gram negative organisms than that causing coronal caries. The presence of Actinomyces viscous is thought to be of special significance. These organisms seen to proliferate among the filiform papillae of the tongue. Tongue brushing twice daily may be an effective means of preventing the root caries. (Massler M 1980)

Similarly, xerostomia as a consequence of aging or caused by medication or irradiation has been implicated as contributing to the etiology of rampant caries. Only a most vigorous effort on the part of the dentist and patient will lead to restoration of the problem. Often this requires the placement of large cervical amalgam or glass ionomer restorations that wrap around the periphery of previously placed cast restorations. Such restorations are difficult to place, yet, in view of the constraints, they are a preferred alternative to comprehensive retreatment with elaborate fixed prosthesis. The reasons for failure of 142 bridges in 130 patients were assessed. The results showed that the mean age of the bridges at failure was 6.2 years. The main single reasons for failure were secondary caries or apical pathology, but many bridges failed as a result of factors related to design and structure. Eighteen percent of the bridges were repaired, recemented or rescued by endodontics alone, 61% were replaced by a new bridge, and the remainder required a removable prosthesis. (L.V. Foster 1990) 3) PERIODONTAL DISEASE : It is unfortunate that periodontal disease often occurs following placement of fixed prosthesis. In some situations, the disease process may be present in both restored and non restored areas of the mouth but with no relationship to the prosthesis. It also can be localized around the prosthesis, as a result of inadequate instruction in prosthesis hygiene, poor implementation of proper hygiene procedures, or a restoration that hinders good oral hygiene. Aspects of a prosthesis that interfere with effective plaque removal include poor marginal adaptation, placing the cavosurface margin subgingivally, overcontouring of the axial surfaces of the retainers, excessively large connectors that restrict the cervical embrasure space, a pontic that contacts too large an area on the edentulous ridge, or a prosthesis with rough surfaces which promotes plaque accumulation.
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Periodontal disease can produce extensive bone loss that in time results in the loss of abutment teeth and attached prosthesis. Less severe breakdown can be treated without fear of loss of the teeth, but treatment often involves surgery, which may produce an unacceptable relationship between the prosthesis and the soft tissue. At recall appointments particular attention is given to sulcular hemorrhage, furcation involvement, and calculus formation as early signs of periodontal disease. A prosthesis that hinders effective plaque removal must be reconstructed or remade to correct such defects. If mobility of bridge abutments is noticed, it may be due to periodontal overloading. This may be result of faulty design, for instance incorporating too few abutment teeth in the prosthesis or due to incorrect occlusion. If former is the case, remake will be necessary, but if latter, occlusal equilibration should be done. 4) OCCLUSAL PROBLEMS : Interfering centric or eccentric occlusal contacts can cause excessive tooth mobility. If this is detected early, the interferences can be eliminated by occlusal adjustment without permanent damage. However, traumatic occlusion on teeth previously weakened by periodontal disease or the long term presence of occlusal interferences on teeth with normal bone support can lead to mobility, which cannot be reduced or eliminated through adjustment of the interfering areas. The prosthesis may have to be removed and the teeth bilaterally braced with a removable partial denture. The patient is examined for signs of occlusal dysfunction at each appointment. An examination of the occlusal surfaces may reveal abnormal wear facts. The canines, in particularly should be inspected because wear here will soon lead to excursive interfering contacts on the posterior teeth. Articulated diagnostic casts should be periodically remade and compared with previous records, so any occlusal changes can be monitored and corrective treatment initiated.
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Occasionally the combination of excessive mobility and reduced bone support require extraction of abutment teeth. The presence of interfering occlusal contacts can also cause irreversible pulpal damage requiring endodontic treatment. Neuromuscular discomfort related to improper occlusion can result in prosthesis failure, since occlusal adjustments that are required to allow the mandible to be properly positioned may cause perforation of the prosthesis or make the restoration esthetically unacceptable. 5) GINGIVAL IRRITATION : The commonest cause of gingival irritation around a prosthesis is plaque retention because of patients poor oral hygiene, because of lack of care or because of the design of the bridge makes this difficult. Other factors may be faulty margins of the retainers, incorrect occlusal anatomy, over contouring of buccal and lingual surfaces, and inadequate interproximal embrasures. Irritation of the mucosa by the pontic may also be due to the wrong choice of material for its fit surface. Acrylic is a particularly bad offender in this respect and the gingival irritation it causes may be further aggravated by the deposition of calculus on it. In some cases local gingivectomy has to be done for satisfactory maintenance of gingiva in region of bridge especially in case of sanitary pontic where gingival proliferation is likely to occur. 6) GINGIVAL RECESSION : This may be local or general. If the former, the reason should be assessed and if possible eliminated. If the latter and there are no aesthetic considerations, such as the exposed, discoloured root of a non-vital tooth, the situation may be acceptable as it stands. However, generalized periodontal therapy may be indicated.

7) PULP AND PERIAPICAL HEALTH : At the recall appointment, the patient may reveal having experienced one or more episodes of pain during the previous months. This could indicate the loss of vitality of an abutment tooth and should be investigated. Appropriate corrective measures can then be taken. Post insertion pulpal sensitivity on abutment teeth that does not subside with time, intense pain, or periapical abnormalities that are detected radiographically often indicate the need for endodontic intervention. One advantage of partial coverage restoration is that pulp health can be monitored with an electric pulp tester, although the vitality of any tooth with a complete crown can still be assessed by thermal means. Access to pulp requires preparation of a hole in the prosthesis through which the necessary treatment is completed. Frequently, the perforation can be restored with gold foil, amalgam, or a cast metal inlay without compromising the prosthesis. The retainer casting may come loose during preparation of the access opening or the porcelain may fracture, necessitating remaking of the prosthesis. During endodontic treatment, an assessment should be made of the quantity and quality of tooth structure remaining for support and retention of the restoration. When little healthy tooth structure remains, it may be necessary to place a post and core and to fabricate a new restoration. It is recommended that endodontically treated teeth be reviewed radiographically every few years. 8) TOOTH PERFORATION : Pinholes or pins used in conjunction with pin-retained restorations can be improperly located and may perforate the tooth laterally. If the perforation is located occlusal to the periodontal ligament, it is often possible to extend the tooth preparation to cover the defect. When the perforation extends in to periodontal ligament, it may be possible to perform
6

periodontal surgery and to smoothen off the projecting pin or place a restoration in to the perforated area. Certain locations (such as furcations) may not be surgically accessible and perforation can lead to extraction of the tooth. Lateral perforations may not be detected initially, becoming apparent only after insertion of prosthesis. Occasionally these perforations are accessible and can be restored with amalgam, but more often the tooth is lost. Endodontic treatment is required when pinholes or pins perforate in to pulp chamber. MECHANICAL FAILURES : 1) LOSS OF RETENTION : A prosthesis can come loose from an abutment tooth, and if this occurrence is not detected early, extensive caries often develops. This loss of retention can be detected in several ways. The patient may be aware of looseness or sensitivity to temperature or sweets. Also, there may be a recurring bad taste or odour, which must be differentiated from similar symptoms caused by poor oral hygiene or periodontal problems. Periodic clinical examinations should include attempts to unseat existing prostheses by lifting the retainers up and down (occlusocervically) while they are held between the fingers and a curved explorer placed under the connector. If the casting is loose, the occlusal motion causes fluids to be drawn under the casting, and when the casting is reseated with a cervical force, the fluid is expressed, generally producing bubbles as the air and liquid are simultaneously displaced. When more than two abutment teeth are involved in a prosthesis, it is much more difficult, and sometimes impossible, to detect a single loose retainers. Removing the prosthesis intact for recementation is often difficult or impossible. Sometimes judicious malleting or the use of a crown remover is successful. Other times a direct pull with hemostat forceps succeeds. (metal7

ceramic crowns should first be coated with autopolymerizing acrylic resin so they do not chip or crack). Even by the use of prolonged ultrasonic vibration, crown retention can be decreased. The effect of prolonged ultrasonic instrumentation on the retention of cemented cast restoration was examined. He concluded that the use of vibration is considered an advantageous adjunct to other cast restoration removal devices (Paul S. Olin 1990). When trying to remove a permanently cemented prosthesis, the dentist must use great caution. Unless force is applied in the path of withdrawl, an abutment tooth may fracture. A loose retainer is usually a sign of inadequate tooth preparation, poor cementation technique, or caries. In this case the tooth requires repreparation and a new prosthesis. Some fixed partial dentures come loose even when maximally retentive preparations have been developed. This problem is generally caused by excessive span length or heavy occlusal forces, and a removable partial denture may be the only satisfactory solution. 2) CONNECTOR FAILURE : An improperly fabricated connector may fracture under functional loading. Failures of both cast and soldered connectors have been observed and are generally caused by internal porosity that has weakened the metal. Depending on the design and location of the FPD, the patient may complain of varying degree of pain. When fracture occurs, pontics are placed in a cantilevered relationship with the retainer casting, and this can allow excessive forces to be developed on abutment tooth. For this reason, the prosthesis should be removed and remade as soon as possible. Wedges can sometimes be positioned to separate the individual FPD components enough to permit the correct diagnosis. In some cases if a solder joint fails,

porcelain facings can be detached by boiling in acid and components are cleaned and relocated in the mouth before they are resoldered. It is sometimes desirable to repair a broken joint in fixed prostheses or to replace one loose crown in a multiple unit splint by using a parallel pin repair rather than to attempt to remove the prosthesis and risk the possibility of destroying the entire restoration or damaging abutment teeth (T.H. Miller and K.E. Thayer 1971). . 3) OCCLUSAL WEAR : Heavy chewing forces, clenching, or bruxism can produce accelerated occlusal wear of a prosthesis. When the occluding surfaces are restored with metal, a casting perforation may develop after several years which allow leakage and caries to occur, which ultimately leads to prosthesis failure. 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. When occlusal surfaces are covered with porcelain, dramatic wear of enamel of opposing natural teeth or the opposing metallic restoration can occur. This problem is exacerbated by heavy chewing forces, or bruxism. So, in mouths where occlusal wear is anticipated, it is better to place metal over occluding surfaces when natural teeth or metallic restorations are present in the opposing arch. 4) TOOTH FRACTURE : Coronal tooth fracture can be minor or considerable loss of tooth structure. Small coronal tooth fractures occurs primarily around inlays and partial coverage crowns as a result of wear and apparent increasing brittleness of tooth structure with age. If the restoration and tooth structure surrounding defect can be adequately prepared and still possess sufficient strength; gold foil, amalgam or resin can be used to restore the area. Large
9

coronal fractures generally requires a full coverage restoration to be made. However, the tooth may require a separate pin-retained restoration to serve as a core and provide support and retention for a new prosthesis. If the fracture causes a pulp exposure, endodontic treatment followed by placement of a post and core is necessary prior to fabrication of a new prosthesis. Abutment tooth fractures under full coverage retainers usually occur horizontally at the level of the finish line, so that little or no coronal tooth structure is left. This condition necessitates removal of the prosthesis, endodontic therapy, a post and core, and a new prosthesis. Several conditions known to promote extensive coronal fractures of abutment teeth are : a) Excessive tooth preparation leaving insufficient tooth structure to resist occlusal forces. b) Presence of interfering centric or eccentric occlusal contacts, or simply heavy occlusal forces on a properly adjusted restoration. c) Attempting to forcibly seat an improperly fitting prosthesis. d) Attempting to unseat a cemented bridge incorrectly. Root fractures are often located well below the alveolar bone crests so that the tooth must be extracted and a new prosthesis fabricated. However, ocasionally the fracture terminates at or just below the alveolar bone. In such cases, it may be possible to perform periodontal surgery, remove bone, and expose the fracture site so it can be encompassed by a new prosthesis. Root fractures are most often caused by trauma. They can also occur during endodontic treatment, forceful seating of a post and core, or the attempt to fully seat an improperly fitting post and core. 5) PONTIC FRACTURE : Mechanical failures of pontic may occur because of inadequate strength. Thus an all-porcelain occlusal pontic should never be used unless the occlusion is favourable. Similarly the gold framework must always be of
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adequate rigidity. Even slight flexion will cause cementation failure or the fracture of the porcelain facing. 6) FLEXION, TEARING OR FRACTURE OF THE GOLD : These may of themselves result in failures of the bridge. They may also result in cementation failures of the retainers or loss of facing. Most of these disasters may be avoided by providing gold of adequate thickness, using a proper casting technique to ensure freedom from porosity, carrying out heat treatment, and making certain that the occlusion is correct. It is also necessary to remember that the longer the span, the stronger and thus the thicker the gold will have to be. 7) CEMENTATION FAILURE : It may be either partial or complete, and is normally the result of retainers which are inadequate for the bridge in question. With fixed-fixed designs if there is any doubt regarding the adequacy of retention and particularly if clinical crowns are short, full crowns showed be employed. The sides of the preparation should be as near parallel to each other as possible. Another important factor is the rigidity of the casting. Even slight flexion will cause cementation failure and this can only be prevented by using a hard gold and making certain that it has been correctly heat-treated and is of sufficient thickness. Besides an inadequate retainer, failure can also occur because of a poor cementation technique. This may be due to the wrong choice of material, failure to observe manufacturers mixing instructions, the use of old or contaminated stock, an inadequate powder / liquid ratio, or the insertion of prosthesis when the cement has started to set. This latter may result in a weak cement and a casting which is incompletely seated. Likewise if the teeth are not dried off carefully before cementation, the bond will be weakened. Where full crowns are being employed, venting is usually indicated.
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Study of 703 resin-bonded fixed partial dentures, the success rates of two study groups were analysed where rebonding or renewals were necessary. Results revealed that rebonding often leads to repeated failures where as renewals showed a failure rate similar to the whole of the investigated failures (C.P. Marinello et al 1990). Evaluation of 137 cantilevered fixed partial dentures made between 1974 and 1990 clinically and radiographically. The results showed that failures occurred more when endodontically treated abutments were used and overall success rate of cantilever fixed prostheses was 70% over a period of 18 years (Veerle Decock et al 1996). Eighty-five patients with a total of 103 resin bonded bridges placed between 1982 and 1989 were evaluated. The results showed that debonding occurred most frequently in the mandibular arch. Failures occurred more frequently in men than in women, and prosthesis with more than two retainers had twice the probability for problems (Paul S. Olin et al 1991). 8) ACRYLIC VENEER WEAR OR LOSS : Abrasion can result in loss of severe amounts of acrylic on acrylic veneer crowns and pontics. Abrasion can be caused by functional loading or abrasive foods and habits, but probably tooth brush abrasion is the most common cause. Repairs may be effected by replacing lost contours with autopolymerising resin. This can be done without removing remaining resin. It may or may not be necessary to add mechanical retention in the form of undercuts or threaded posts. The composites are now becoming more popular for these repairs. They are more resistant to wear and maintain function and appearance longer than acrylic resin repairs.

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9) PORCELAIN FRACTURE : A) METAL CERAMIC PORCELAIN FAILURES : 1) FRAMEWORK DESIGN : Sharp angles or extremely rough and irregular areas over the veneering area serve as points of stress concentration that can cause crack propagation and ceramic fracture. Perforations in the metal can also cause failure for the same reason. When the framework thickness is less than 0.2mm over large areas of the veneering surface, the potential for failure is much greater regardless of the type of casting alloy. Porcelain fracture may also occur if the framework design allows centric occlusal contact on, or immediately next to, the metal-ceramic junction or the angle between the veneering and nonveneered aspect is less than 90 degrees. These designs allow occlusal forces to cause localized burnishing of the metal and distortion, which leads to premature porcelain fracture. 2) OCCLUSION : The presence of heavy occlusal forces or habits such as clenching and bruxism and centric or eccentric occlusal interferences can cause failure. 3) METAL HANDLING PROCEDURES : Improper handling of the alloy during casting, finishing, or application of porcelain can lead to metal contamination which can create stress and possibly cracks. Excessive oxide formation on the alloy surface can also cause separation of the porcelain from the metal. This is most frequently caused by improper conditioning of the alloys. 4) PREPARATION, IMPRESSION AND INSERTION : A tooth preparation with a slight undercut can cause binding of the prosthesis as it is seated, which initiates a crack in the porcelain. An impression that is slightly distorted can also lead to some problem. Teeth prepared with a feather edge finish lines or impressions that do not record all of the finish line can lead to an extension of metal beyond the
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actual termination of tooth reduction and this thin metal may bind against tooth and initiate a crack in the overlying porcelain. Definite finish lines and impressions that record proper detail are prerequisites to acceptable ceramics. Attempts to achieve complete seating of a ceramic restoration by using a mallet and wooden stick during trial insertion or cementation can also produce porcelain fracture. 5) METAL AND PORCELAIN INCOMPATIBILITY : In rare instances, an alloy and porcelain are found to be truly incompatibly and successful bonding without loss of the veneer or cracking is impossible. PORCELAIN JACKET CROWN FAILURES : All ceramic restorations are more likely to fail in the presence of heavy occlusal forces, clenching or bruxism. The preparation from must be ideal to optimize success. 1) VERTICAL FRACTURE : The reasons for this are : a) If tapered finish line is used (such as chamfer), the restoration may contact on a sloping surface, so that the forces attempt to expand the prosthesis and leading to vertical fracture. b) Sharp line angles or incisal edge which acts as area of stress concentration. c) When a large portion of the proximal preparation form is missing and is not restored prior to the impression procedure. When occlusal forces are applied to the marginal ridge, greater leverage is developed because of the distance from the point of force application to the underlying prepared tooth which can cause rotation of prosthesis and leading to expansive forces and vertical fracture.

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2) FACIAL CERVICAL FRACTURE : It often assumes a semilunar from and generally occurs with a short tooth preparation. The inciso-cervical length of the preparation should be two-thirds to three-quarters that of the final restoration. When the preparation is short, forces applied at the incisal edge attempt to tip the prosthesis facially and cause cervical porcelain fracture. When opposing tooth contact is located incisally to the prepared tooth, tipping forces are more frequently developed, with the restoration having a fulcrum on the cervically located incisal edge. This occlusal relationship can also lead to facial cervical porcelain failures. 3) LINGUAL FRACTURE : Semilunar lingual fractures are observed when the occlusion is located cervically to the cingulum of the preparation, where forces on the porcelain are more shear in nature and not as well resisted. Other lingual fractures, not necessarily semilunar in form, are the result of inadequate lingual tooth reduction in which less than 1mm of porcelain is present. Exceptionally heavy occlusal forces can also cause lingual fractures even when adequate porcelain thickness is present. REPAIR OF FRACTURED PORCELAIN VENEER : If the porcelain has fractured on an otherwise satisfactory multi-unit prosthesis, to save the patient from additional discomfort, time and expense, an attempt at repair rather than a remake may be justified. When the fractured porcelain is not missing and there is little or no functional loading on fractured site, it can sometimes be bonded in place with a porcelain repair system using silane coupling agents or 4-META to promote bonding with acrylic or composite resin. These repairs appear to have reasonable strength. Unfortunately, however-the strength of joints diminish with changes in temperature and with prolonged water storage. Such repair is considered to have only temporary benefit.
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The flexural strength of porcelain bonded to composite resin specimens using four organosilane materials were compared. The results showed that unhydrated specimens had significantly higher bond strength than the hydrated specimens with all products (J. H. Bailey 1989). The effectiveness of two new porcelain repair systems which use coupling agents were compared. The results showed that the repair system using a bonding agent with acrylic resin is significantly stronger than repair system using a specific composite resin (R.M. Highton et al 1979). The bond strength of 4-META (etch free primer with C and B metabond) to porcelain was evaluated. The mean bond strengths were : 24 hours 17. 4 MPa ( 4.8), thermocycled 19.1 MPa ( 7). These bond strengths were comparable with or exceed those of other porcelain repair systems tested (Robert L. Cooley et al 1991). The bond strength of three commercial composite resins advocated for repairing dental porcelain was evaluated. They concluded than mean strength of repaired samples was only 18% of the original strength which indicates that their use is a temporary clinical procedure (Thomas P. Nowlin et al 1981). The bond strengths of porcelain / composite resin repair samples was evaluated. They concluded that the mean bond strengths were significantly less after storage in water for 28 days and fractures of all specimens were caused by adhesive failures occurring at the interface (William A. Gregory et al 1988). In either circumstances, the factures area may be repaired with composite resin retained by means of mechanical undercut and use of silane coupling agent.

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A technique for repairing fractured porcelain fused-to metal restoration has been presented. Mechanical retention on the coping must be created. The porcelain is beveled and etched and treated with silane. The metal is masked with a mix of unfilled resin and the corresponding shade of porcelain opaque powder. Then the surface is rebuilt with a microfilled resin and finished by conventional methods (M.T. Barreto, B.F. Bottaro 1982). A more permanent repair can sometimes be effected by making a metal ceramic restoration to fit over the fractured original and it is appropriate where pontic has fractured. The most commonest difficulty in this is weakening of connectors during preparation with associated risk of subsequent fracture of the prosthesis. There are no satisfactory methods for repairing fractures of allceramic restorations, a new restoration must be fabricated, and if it is due to excessive occlusal forces which exceed the strength of the restoration, a metal ceramic restoration should be considered. ESTHETIC FAILURES : Ceramic restorations more often fail esthetically than mechanically or biologically. Remakes occur more frequently because of poor colour match than for any other reason. It may be due to : a) Inability to match the patients natural teeth with available porcelain colours. b) Inadequate shade selection. c) Metamerism may contribute to poor colour matching d) Insufficient tooth reduction e) Failure to apply and fire porcelain f) Incorrect form of framework design that displays metal. g) Natural teeth undergo colour changes that do not occur in porcelain, so an unacceptable colour match is caused over the years.

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h) Partial veneer crowns can be esthetically unacceptable because of overextension of the finish line facially. i) Visibility of metallic colour of partial coverage casting if thin incisors are prepared. j) Marginal fit or cervical form of a prosthesis can promote plaque accumulation, causing gingival inflammation, which produces unnatural soft tissue colour or form that is esthetically unacceptable. FACING FAILURES : Recementation of a loose facing is indicated if the prosthesis is otherwise satisfactory. A new facing can be ground to fit the prosthesis which is done on a trial and error basis and often does not yield ideal fit. Another repair process is to rebuild the desired form with a resin. Pins can be cemented or threaded into the casting if necessary to facilitate retention of resin. REMOVAL OF THE PROSTHESIS : It can be done by four different methods. It is essential that forces be applied in the correct direction, if the fracture of the abutment teeth is to be avoided. 1) CROWN REMOVER : It is the best method because it is relatively easy to see that the force is being exerted in correct direction. Initially after placement of the hook at the cervical margin, a few light blows are given to provide a surface on to which the hook can engage. Then jerks are given on the end of handle, thus applying a sudden blow to the retainer and simultaneously second retainer should be held firmly in place by a assistant. Sometimes, it may also be used below the pontic. 2) USE OF A STRAIGHT CHIESEL : This is generally used as a means of applying force to a retainer on which one cannot use a crown remover. Initially, the chisel is placed either
18

mesially or distally, at an angle of 450 and tapped sufficiently to create a facet. Then it is positioned paralled to the line of withdrawl of retainer and sudden fairly hard blow, of which the patient should have warning, is then applied. 3) USE OF A BRASS LIGATURE WIRE : A 4 feet length of wire is threaded between the pontic and retainer sothat a loop is created. A metal bar is put through this loop, one end of it held firmly, and a sudden blow applied to the other end. Great care must be taken so that the wire does not cut the patient lips. 4) USE OF A SCREW THREAD : When the retainer has a gold occlusal surface, a small hole may be drilled in this and then tapped. A threaded bolt is now inserted into the hole until it reaches the bottom. If the bolt continues to be turned, its base will then press on the tooth tissue, and with a little good fortune, will elevate the casting from the tooth. Should all the above methods fail, the retainer must be weakened, in the case of full crown by cutting up its side and in case of three-quarter crown by cutting across the occlusal surface. It will then be possible to apply an instrument which will spread the crown slightly and break the cement seal. CONCLUSION: The first consideration when confronted with any failure or repair situation is to ascertain the cause or suspected cause. If there is a cause that is correctable, it should be taken care of first. Care should be taken not to become involved in repairs that should have been remakes. Repairs are usually the second best to the original in one or more ways. Imagination and innovation are key factors in successful repairs. Great satisfaction can be achieved in meeting a situation and solving it in an effective and economical manner.
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BIBLIOGRAPHY :
1) Contemporary fixed prosthodontics, Stephen F. Rosenstiel 3rd edition 2) Modern practice in fixed prosthdontics, Johnsion, 4th edition.

3) Fixed prosthodontics, Keith E. Thayer

4) Fixed bridge prostheses, D.H. Roberts, 2nd edition.

5) Walton J.N, F Michael Gardner, John R. Agar, A survey of crown and fixed partial denture failures. Length of service and reasons for replacement, JPD 1986, 56(4), 416-21. 6) Massler M : Geratric dentistry : Root caries in the elderly, JPD 1980, 44, 147. 7) L.V. FOSTER: Failed conventional bridge work from general dental practice : clinical aspects and treatment needs of 142 cases, Br Dent J 1990; 168, 199-201. 8) Paul . S. Olin : Effect of prolonged ultrasonic instrumentation on the retention of cemented cast crowns, JPD 1990; 64, 563-5. 9) Thaxter H. Miller, Keith E. Thayer, Intra oral repair of fixed partial dentures; JPD 1971; 25(4), 382-388. 10) J.H. Bailey, Porcelain-to-composite bond strengths using four organosilane materials, JPD 1989, 61, 174-7. 11) R.M. Highton, A.A. Caputo, J. Matyas, Effectivness of porcelain repair systems, JPD 1979; 42 (3), 292-294. 12) Robert L. Cooley, Engene Y. Tseng, James. G. Evans, Evaluation of 4-META porcelain repair system, J Esthet dent; 3 (1), 11-13. 13) Thomas P. Nowlin, Nasser Barghi, Barry K. Merling, Evaluation of the bonding of three porcelain repair systems, JPD 1981; 46(5), 516-518.

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14) William A. Gregory, Charles. A. Hagen, John. M Powers, Composite resin repair of porcelain using different bonding materials, oper detn 1988; 13, 114-118. 15) M.T. Barreto, B.F. Bottaro, A practical approach to porcelain repair, JPD 1982; 48(3), 349-51. 16) C.P. Marinello, Th. Kerschlaum, P. Pfeifer, P.D. Repell, Success rate experience after rebonding and renewal of resin bonded fixed partial dentures, JPD 1990, 63,8-11. 17) Veerle Decock, Katrien De Mayer, Jan . A. De Boever, 18 year longitudinal study of cantilevered fixed restorations, IJP 1996; 9, 331-340.
18) Paul S. Olin, Elaine M.E. Hill, James L. Donahue, Clinical

evaluation of resin bonded bridges: a retrospective study, QI 1991; 22, 873-877.

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1) INTRODUCTION 2) BIOLOGIC FAILURES a) Caries b) Root caries c) Periodontal disease d) Occlusal problems e) Gingival irritation f) Gingival recession g) Pulp and periapical health h) Tooth perforation 3) MECHANICAL FAILURES a) Loss of retention b) Connector failure c) Occlusal wear d) Tooth fracture e) Pontic fracture f) Flexion, tearing or fractures of the gold g) Cementation failure h) Acrylic veneer wear or loss i) Porcelain fracture - Metal-ceramic porcelain failures - Porcelain jacket crown failures 4) ESTHETIC FAILURES 5) REMOVAL OF THE PROSTHESIS 6) CONCLUSION 7) BIBLIOGRAPHY

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DEPARTMENT OF PROSTHODONTICS INCLUDING CROWN AND BRIDGE

COLLEGE OF DENTAL SCIENCES DAVANGERE

SEMINAR ON

COMPLAINTS AND FAILURES OF FIXED PARTIAL DENTURES

Presented By DR. NITIN GAUTAM

(2001-2002)

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