RESIN RETAINED FPD

Introduction:

• It is a fixed partial denture that is luted to tooth structures, primarily

enamel, which has been etched to provide micro mechanical retention for
the resin luting agent (GPT -9)

 The resin-bonded fixed partial denture is a conservative restoration that is

reserved for use on defect-free abutments in situations where there is a
single missing tooth, usually an incisor or premolar.

Classification :

RESIN RETAINED FPD

Rochette bridge Maryland bridge Virginia bridge

Cast perforated resin- Etched cast resin-retained Macroscopic mechanical

retained retention resin retained
(MICROMECHANICAL
(MECHANICAL RETENTION) RETENTION)

Rochette bridge :

• Concept of bonding metal to teeth using flared perforations ( Wing like

retainers) of the metal casting to provide mechanical retention.
 • Combined mechanical retention with a silane coupling agent to produce
adhesion to the metal.
• Principally for periodontal splinting

• Perforation technique presents the following limitations:

1. Weakening of the metal retainer by the perforations
2. Exposure to wear of the resin at the perforations
3. Limited adhesion of the metal provided by the perforation

Disadvantages of Rochette bridge :

• Limited retention provided by the composite retained metal

• The thickening of the metal retainers required to compensate for the
weakening effect of the perforations
• The wear of the resin cement

Maryland bridge : (Thompson and Livaditis)

• An electrolytic etching procedure for non precious ceramic bonding alloy to

provide a microporous surface taht allows micromechanical interlock with
cement
 • Thinner wings and no perforation
• Done in either 2 step process or one step process bot are equally retentive

Advantages over cast perforated restoration :

1. Retention is improved because the resin-toetched metal bond can be

substantially stronger than the resin-to-etched enamel. The retainers can
be thinner and still resist flexing.
2. The oral surface of the cast retainers is highly polished and resists plaque
accumulation.

Disadvantages of Maryland bridge :

1. Electrochemical etching is technique sensitive.

2. Overetching produces an electropolished surface, and contamination of the
surface reduces bond strength

Virginia bridge : (Lost salt technique)

• Particle-roughened retainers by incorporating salt crystals into the retainer

patterns to produce roughness on the inner surfaces.
 • Sieved cubic salt crystals (NaCl), ranging in size from 149 to 250 μm, were
sprinkled over the outlined area.
• The retainer patterns were fabricated from resin, with a 0.5- to 1.0-mm-
wide crystal-free margin around the outlined area.
• After the resin was polymerized, the patterns were removed from the cast,
cleaned with a solvent, and placed in water in an ultrasonic cleaner to
dissolve the salt crystals.
• This left cubic voids in the surface that were reproduced in the cast
retainers, producing retention for the fixed partial denture.
• Surface treatment – air abrasion with aluminium oxide

Advantages and disadvantages :

1. Adequate bond strengths are possible with this method, but the thickness
of the casting must be increased to allow for the undercut thickness.
2. Time saving
3. With this technique, it does permit the use of almost any metal-ceramic
alloy.

MACROSCOPIC RETEBTION ALTERNATIVE TECHNIQUE :

• Use of a cast mesh pattern on the internal surface of the retainers

• The mesh, usually made of nylon

• Should be adapted to the lingual and proximal surfaces of the abutments.
 • The mesh is then covered by wax or resin. This must be done carefully to
prevent occluding the mesh with the pattern material.
• Investing and casting then follow
• This method is technique sensitive but can provide adequate retention with
a resulting thick lingual casting.
• The cast mesh and the lost salt crystal method have been supplanted by
direct adhesion with resin, which is possible for most casting alloys if the
correct surface treatment is provided.

STEPS IN FABRICATION:

Preparation of the abutment teeth

Design of the restoration

Bonding
DESIGN OF RESTORATION :

PRINCIPLE

• Proper patient selection, correct enamel modification, and framework

design.
• Necessary to cover as much enamel surface as possible, as long as
occlusion, esthetics, or periodontal health are not compromised.

• Designs of etched cast retainers included an "interproximal wraparound"

concept developed to resist occlusal forces and provide a broader area for
bonding.

• Enamel preparations for creating occlusal clearance, placement of

occlusal/cingulum rests, and lowering the lingual and proximal height of
contour, thus creating proximal extensions.
• Frameworks should seat in an occlusogingival direction and should have no
facial-lingual displacement
• The contemporary design has improved retention with well-placed and
precise grooves on abutment teeth

PREPARATION OF THE ABUTMENT TEETH :

Benefits of tooth preparation for RBFPD prostheses:

1. Prepared enamel provides a stronger resin-to enamel bond than

unprepared enamel.
2. Greater occlusal clearance is provided for the retainers of maxillary
anterior RBFPDs.
3. Space is provided for the RBFPD retainers so they more nearly reproduce
the original tooth contours.
4. A positive seat for the restoration is provided which assures proper
placement of the restoration during bonding and reduces shearing stress
on the resin to-enamel bond during function.
5. Tooth preparation provides a tooth-to-metal finishing line that is smooth
and cleansable.

MAXILLARY ANTERIOR TOOTH PREPARATION

• Patients with class II occlusal relationships with a deep horizontal overlap

may be more difficult to treat with a resin-bonded prosthesis in the
maxillary anterior region than patients with either a class I or class III
occlusion
• The cervical finishing line of the retainer should be either 1 mm incisal to
the cementoenamel junction or no more than 1 mm incisal to the free
gingival margin.
• Because available enamel thickness at this site is approximately 0.25 mm,
no more than a light chamfer finishing line should be used.
• In most instances the casting thickness will exceed the amount of enamel
removed.
• Therefore, for an optimum periodontal response the finishing line should
always be placed incisal to the free gingival margin.
• The finishing line on the proximal surface adjacent to the edentulous space
should be placed as far facially as practical without altering the outline form
of the tooth.
• A shallow groove 0.5 mm in depth, prepared with a No. 169 L bur, should
be placed slightly lingual to the labial termination of the proximal
reduction.
• The tooth structure lingual to the groove should be prepared in a flat plane
terminating cervically in a knife-edge finishing line 1 mm from the free
gingival margin.
• The proximal slices on adjacent teeth should have an occlusal divergence in
the range of approximately 6 degrees to 15 degrees.
• Although it is desirable to place the groove entirely in enamel,
penetrations into dentin should not result in a significant loss of bonding
area if the No. 169 L bur is used carefully.
• The incisal finishing line should be lightly chamfered and placed as near to
the incisal edge as esthetic considerations will permit.
• The objective should be to cover the maximum amount of tooth structure
possible without displaying metal or graying on the incisal edge.

MANDIBULAR ANTERIOR TOOTH PREPARATION

• The lingual surfaces are not in occlusion, the preparation need only be
enough to remove the surface enamel.
• There is sufficient enamel to place a beveled or light chamfer finishing line
as near to the incisal edge as esthetic considerations will permit.
• The lingual and proximal cervical finishing lines should be a definite knife-
edge or a light chamfer placed on enamel and should be 1 mm incisal to the
cementoenamel junction (CEJ) or no more than 1 mm incisal to the free
gingival margin.
• Because the cingulum of mandibular anterior teeth is usually poorly
developed, a positive cingulum rest seat may be provided to assure correct
positioning during bonding.
• However, a cingulum rest seat is likely to expose dentin and subsequently
reduce the bonding surface.
• An alternative approach is to provide an incisal hook on the cast retainer

INCISAL HOOK
 POSTERIOR TOOTH PREPARATION

• Unless the abutment teeth are severely tipped in relation to each other, the
proximal slices should be at least 2.5 to 3 mm in an occlusogingival
dimension.
• If an abutment tooth is significantly tipped, the proximal slices should be as
long as possible without exposing dentin.

• A portion of the occlusal surface, particularly that not in occlusion, may be

prepared and covered with the retainer to supplement the loss of surface
area due to the short proximal slice and to restore occlusal function.

• If esthetics is not an important consideration, the proximal slice may be

extended beyond the proximofacial line angle to provide resistance to
lingual displacement
• Where a proximal slice is not possible a shallow box or groove should be
placed in the enamel as near the proximofacial line angle as possible.
• Because posterior teeth have a bell-shaped proximal surface, a knife-edged
finishing line on the proximocervical surface is most desirable and least
likely to expose dentin.
• The proximal slices on adjacent teeth should have an occlusal divergence of
approximately 6 degrees to 15 degrees.
• A positive rest seat should be prepared in each marginal ridge adjacent to
the edentulous space.
• An ideal rest seat is spoon shaped with a depth of 1 mm, a buccolingual
width of 2.5 to 3 mm, and a mesiodistal width of 1 to 1.5 mm .
• However, the rest seat should be designed with consideration of the size of
the tooth, its position in the arch, and its occlusal relationships with
adjacent and opposing teeth.
• The lingual surfaces of mandibular posterior teeth are usually prepared in a
single plane, terminating cervically with a knife-edge or light chamfer
finishing line.
• This portion of the preparation should be at least 3 mm in an
occlusocervical dimension, with a shallow groove on the facial line angle
opposite the edentulous space.
• The shape of maxillary molars make them more difficult to prepare for
resin-bonded abutments than mandibular molars. The lingual surface
 tapers buccally in the occlusal two thirds of the tooth and the outer incline
of the lingual cusp is usually in occlusion.
• Therefore, the lingual surface should be prepared in two planes.

BONDING :

• Composite resins play an important role in bonding the metal frame work
to etched enamel.
• Conventional BIS-GMA type resins are originally used for luting resin-
retained FPDs

STEP-BY-STEP BONDING PROCEDURES :

1. Clean the teeth with pumice and water. Isolate them with the rubber dam
and acid etch with 37% phosphoric acid for 30 seconds. Rinse, dry, and
maintain air drying until the primer is applied.
2. Primer applied to teeth and left for 60 seconds.
3. Resin pastes dispensed and mixed over wide area for 25 secs.
4. Dry the Primer to ensure evaporation of the solvent (this should remain on
the enamel surface for 30 seconds before drying)
5. Apply resin cement to inner surface of casting
6. Seat the casting firmly and maintain pressure while removing the excess
resin cement with a brush or pledget. The cement will set within 60 to 90
seconds under the casting but not at the margins, which are exposed to air.
7. Light-cure the margins
8. Major finishing, polishing, and occlusal adjustments should be performed
before bonding the restoration

Conclusion :

• Conservation of tooth structure is the primary advantage of resin-retained

fixed partial dentures.
• Precision and attention to detail are important in resin-retained fixed
partial
• To provide a long-lasting prosthesis, the practitioner must plan and
fabricate a resin-retained restoration with the same diligence used for
conventional restorations.
• Careful patient selection is an important factor in predetermining clinical
success.