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Review Article

Different classification system for failures in tooth

supported fixed partial denture: A systematic review
ABSTRACT
Fixed prosthodontic treatment can offer exceptional satisfaction for both patient and dentist but failure may occur at any time right from diagnosis
to treatment phase which can be frustrating. The dental literature is lacking in classification of failures in Fixed partial dentures. The cause may
be that signs and symptoms of failures are varied and often complex and there is the additional problem of reaching a common interpretation
among investigators on the definition of failure. When dealing with failed or failing fixed restorations, proper knowledge of diagnosis, assessment
of the clinical condition and technical skills are absolutely necessary. Hence it is important to be aware of obvious and subtle indications of
prosthesis failure and have a working knowledge of the procedure that are necessary to remember the situation. This review focusses on
classification systems of failures associated with tooth supported fixed partial denture proposed by different authors.

Keywords: Classification systems, failure in fixed partial denture, objectives of fixed prosthodontic treatment, prosthesis failure

INTRODUCTION • Preservation or improvement of oral function

Fixed prosthodontic treatment can offer exceptional
satisfaction for both the patient and dentist. To achieve
such success, however, requires meticulous attention to
every detail from initial patient interview, through the active
treatment phase, to a planned schedule of follow‑up care.
Fixed prosthodontic failures can be frustrating and complex
in terms of both diagnosis and treatment and may occur at
any time. Hence, it is important to be aware of obvious and
subtle indications of prosthesis failure and have a working
knowledge of the procedure that are necessary to remember
the situation.[1]
Before calling any fixed tooth‑supported prosthesis as
“Failing” or “Failed” implant, there are certain objectives
which a fixed prosthesis should fulfill. Failing to fulfill
these objectives leads to failures in fixed prosthodontic
• Improvement or restoration of esthetics
• Ensuring restoration retention, resistance and
stability
• Providing restoration with mechanical or structural
integrity
• Preserving or improving patient comfort
• Designing restorations for maximum longevity.
C L A S S I F I C AT I O N S Y S T E M F O R FA I L U R E S I N
TOOTH‑SUPPORTED FIXED PARTIAL DENTURE
“Tinker”[4] was the first one to summarize the causes of FPD
failures as early as in 1920. Chief among the causes for such
disappointing results were:
V. Chandrakala1, S. Deepmala2, G. Srivatsa3
1
Reader, 2Senior Lecturer, 3Professor, Department of

treatment.[2] Prosthodontics, K.L.E Society’s Institute of Dental Sciences,

Bengaluru, Karnataka, India

OBJECTIVES OF FIXED PROSTHODONTIC TREATMENT [3] Address for correspondence: Dr. V. Chandrakala,

Department of Prosthodontics, K.L.E Society’s Institute of Dental
Sciences, Bengaluru, Karnataka, India.
• Preservation and improvement of related hard‑  and E‑mail: drchandra10@gmail.com
soft‑tissue structures

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DOI:
How to cite this article: Chandrakala V, Deepmala S, Srivatsa G. Different
10.4103/INPC.INPC_15_19 classification system for failures in tooth supported fixed partial denture: A
systematic review. Int J Prev Clin Dent Res 2019;6:17-20.

© 2019 International Journal of Preventive and Clinical Dental Research | Published by Wolters Kluwer ‑ Medknow 17
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Chandrakala, et al.: Classification of tooth supported FPD

• First: Faulty or no attempt at diagnosis and prognosis Barreto [7] classification – 1984

• Second: Failure to remove foci of infection 1. Biologic – caries, fractures, and generalized periodontal
• Third: Disregard for tooth form disturbances
• Fourth: Absence of proper embrasures 2. Esthetics – shapes, contours, and surface characteristics
• Fifth: Interproximal spaces 3. Biophysical – physical properties and chemical
• Sixth: Faulty occlusion and articulation. composition of porcelain and metal
4. Biomechanical – faulty designs, misplaced finish lines,
Robert’s classification [5] rough or sharp surfaces, and undercuts on the bonding
• Cementation failure surface cause porcelain to be dislodged.
• Mechanical breakdown
• Flexion, tearing, or fracture of the gold Thayer [8] classification – 1984
• Solder joint failure • Caries
• Pontic fracture • Cement failures
• Bonded porcelain failure • Preparation fractures and acrylic veneer wear/loss
• Gingival irritation or recession • Porcelain fractures
• Periodontal breakdown • Solder joint or major connector failure
• Caries • Periodontal involvement.
• Necrosis of the pulp.
Selby [9] classification – 1984
Lombardi classification of esthetic errors  [6]
Biologic
1. Inharmonious dentofacial ratio • Caries
• Shade disharmony • Periodontal disease
• Compositional incompatibility • Endodontic or periapical problems.
•  Static prosthesis in dynamic mouth
•  Inharmonious strength or weakness of dental Mechanical
composition compared to background features • Loss of retention
•  Weak mouth with strong face • Fracture or loss of porcelain
•  Strong mouth with weak face. • Wear or loss of acrylic veneer
2. Intrinsic dental disharmony • Wear or perforation of gold
• Space allocation errors • Fracture of metal framework
•  Inadequate vertical space allocation • Fracture of solder joints
•  Excessive vertical space allocation • Fracture of abutment tooth or root
•  Excessive horizontal space allocation • Defective margins
• Structural line errors • Poor contour
•  Elevated occlusal plane • Poor esthetics.
•  Occlusal plane drops down posteriorly
•  Asymmetrical occlusal plane. Wise[10] classification – 1999
3. Unnatural lines 1. General pathosis
• Reverse smiling line 2. Periodontal problems
• Unnatural axial inclination 3. Caries
• Cusp less posterior teeth 4. Pulpal changes
• Gradation errors 5. Erosion
• Age–sex personality disharmony. 6. Cracked teeth
4. Single‑line errors 7. Subpontic inflammation
• Vertical deviation 8. Temporomandibular joint disorders
• Horizontal deviation 9. Occlusal problems.
• Line conflict.
5. Imbalance Smith [11] classification – 1985
• Midline error 1. Loss of retention
• Imbalance of directions 2. Mechanical failures of crown and bridge components
• Artifact error 3. Changes on abutment tooth
• Diastema error. 4. Design failures

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Chandrakala, et al.: Classification of tooth supported FPD

5. Inadequate clinical or laboratory technique • Class VI – Severe failure with loss of supporting tooth
a. Marginal deficiencies or inability to reconstruct using original tooth support.
b. Defects Conventional fixed prosthodontic replacement is not
c. Poor shape and color possible.
6. Occlusal problems.
DISCUSSION
John. F. Johnston [12] classification – 1986
Biological failures Fixed prosthodontic failures are varied and often complex
• Caries in cause and effect. A Medline and an extensive hand
• Root caries search performed for the last 50 years showed that the
• Periodontal disease most common complications associated with conventional
• Occlusal problems fixed partial dentures were caries (18% of abutments and
• Gingival irritation 8% of prostheses), need for endodontic treatment (11%
• Gingival recession of abutments and 8% of prostheses), loss of retention (7%
• Pulp and periapical health of prostheses), esthetics (6% of prostheses), periodontal
• Tooth perforation. disease (4% of prostheses), tooth fracture (3% of prostheses),
and prosthesis/porcelain fracture (2% of prostheses). The best
Mechanical failures way to lessen the fixed dental prosthesis failures is to have
• Loss of retention a sound knowledge of diagnosis and treatment procedures,
• Cementation failure but many times, failures too occur even after meticulous
• Acrylic veneer wear or loss attention paid. Hence, it is important to know about various
• Porcelain fracture classification systems available in the literature for better
• Metal‑ceramic porcelain failures management of failures wisely in tooth‑supported fixed
• Porcelain jacket crown failures. partial denture.[13‑18]

Esthetic failures CONCLUSION

• Improper shade selection
• Excessive metal thickness and exposure The classification systems presented in this review for failures
• Thick opaque layer application 7 overglazing in tooth‑supported fixed partial denture identify trends that
• Dark space in cervical third can be effectively and wisely used to develop treatment
• Failure of translucency plans that optimize success and to communicate appropriate
• Improper contouring expectations to patients.
• Discoloration of facing.
Financial support and sponsorship
Facing failures Nil.

Manappallil [3] classification – 2008 Conflicts of interest

• Class I – Cause of failure is correctable without replacing
restoration
• Class II – Cause of failure is correctable without replacing
restoration; however, supporting tooth structure or
foundation requires repair or reconstruction
• Class III – Failure requiring restoration replacement only.
Supporting tooth structure and/or foundation acceptable
• Class IV – Failure requiring restoration replacement in
addition to repair or reconstruction of supporting tooth
structure and/or foundation
• Class V – Severe failure with loss of supporting tooth
or inability to reconstruct using original tooth support.
Fixed prosthodontic replacement remains possible
through the use of other or additional support for
redesigned restoration
There are no conflicts of interest.
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