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Australian Dental Journal 1994;39(3):150-6

Fixed prosthodontic failure.


A review and discussion of important aspects

Alex Selby, BDS, MDS(Syd)

results of laboratory studies cannot always be accepted


Abstract without question; in v i m experiments may not always
In order to justify the time and expense involved in reflect the clinical circumstances or outcome. Neverthe-
complex restorative treatment there is an expecta- less, with judicious interpretation non-clinical studies offer
tion of a favourable result and long-term success. insight into anticipated clinical behaviour.
Longevity in fixed prosthodontics is not only depen- A search of the dental literature on fixed prosthodontics
dent upon the precision and skill with which the work reveals very few longitudinal or cross-sectional clinical
is carried out, but also to a large degree upon a studies. Comparisons of the available reports are difficult
proper assessment and diagnosis and the utilization because the published papers often vary with respect to
and implementation of valid principles of design. the nature and design of their study or the material being
This paper reviews the literature in an attempt to examined. For instance, the prosthodontic treatment may
determine the incidence of failure and the reasons have been carried out by private general dentists, by senior
for, and types of, failures that occur. There is a undergraduate students, or within a specialist clinic; and
consideration of some factors important in pre- by numerous clinicians or by the one operator. Further-
operative assessment and a detailed discussion of more the authors often vary in their definition of failure.
various aspects of design for fixed prosthodontic Failure of a fixed prosthesis can occur in many ways.
restorations. The reasons for failure may, for the purposes of discus-
Key words: Fixed prosthodontic, review, failure.
sion, be divided into biological problems and mechanical
problems; they are listed in Table 1. Whereas mechan-
(Received for publication August 1992. Revised November ical problems are, in general, more directly under the
1992. Accepted January 1993.)
influence of the clinician, the biological problems are less
easily controlled and in some instances may be unrelated
to the treatment or prosthesis.
However, the converse is also true and many times the
Introduction biological problems may be a consequence of the treat-
Because the tolerances are minute and the field of oper- ment procedures (for example, pulpal problems) or of the
ation restricted, and because restorations must survive in restorations themselves (for example, caries), if they are
a demanding biological environment over which there is deficient in execution or design.
little control, the practice of fixed prosthodontics will Nyman and Lindhe' presented a study of 251 patients
always yield a certain percentage of unsatisfactory results. with advanced periodontal breakdown who, following
Yet one of the most frustrating and demoralizing aspects comprehensive periodontal treatment, received 332 fixed
of dental practice is to be confronted by the failure of work, prostheses and were followed for 5 to 8 years. Their
despite careful planning, meticulous attention to detail patients were a very select group with marked bone loss
and the application of a great deal of time and effort. and complex prostheses, often with very long spans and
A consideration of the nature and frequency of failures long cantilevered sections. T o their advantage, the abut-
and an examination of the circumstances that lead to ment teeth had long clinical crowns, facilitating the
failure may help identify potential problems and provide development of good retention form in the abutment
a basis from which to make more reliable judgments with preparations, and the metal frameworks were able to be
regard to treatment planning. made correspondingly thicker to provide greater strength
in the prosthesis.
The incidence of failure Periodontal health was maintained in all cases; however,
Theories and principles related to the practice of fixed 7.8 per cent of the bridges experienced failures of a
prosthodontics have to a large degree been obtained by technical nature. The failures were due to loss of reten-
reasoning, clinical observations, anecdotal reports and tion (3.3 per cent), fracture of the bridgework (2.1 per
extrapolation from laboratory experiments. However, the cent), and fracture of the abutments (2.4 per cent).
150 Australian Dental Journal 1994;39:3.
Table 1. Reasons for failure of fixed prostheses rate of 4 per cent after 5 years, 12 per cent after 10 years,
Biological problems
and 32 per cent after 15 years.
Caries It becomes apparent with any discussion on failures of
Periodontal disease treatment that in order to maintain a balanced outlook
Endodontic or periapical problems
Mechanical problems
one must also consider longevity of service. For example
Loss of retention a restoration that becomes unserviceable after 30 years
Fracture or loss of porcelain of service cannot truly be considered a failure.
Wear or loss of acrylic veneer
Wear or perforation of gold
Schwartz et aI.’ examined 406 patients with failed
Fracture of metal framework crowns and bridges in order to survey the reasons for
Fracture of solder joints failure and the life span of the restorations that had failed.
Fracture of abutment tooth or root The average life span for all the failed restorations in their
Defective margins
Poor contour study was 10.3 years; 20 per cent failed within 3 years,
Poor aesthetics and 22 per cent lasted more than 16 years.
The most frequent cause for failure was caries (36.8 per
cent). However, this occurred on average after 11 years,
Reuter and Brose2 reviewed 121 bridges constructed which is a longer life than the average age at which failure
over an 11-year period, made by the one clinician in a occurred. The second most frequent cause for failure was
private practice. The average review period was 4.9 years uncemented crowns (12.1 per cent) and this occurred, on
from the time of construction. Ninety-one per cent of the average, after only 6.8 years. This was a significant cause
bridges were porcelain fused to gold and the remainder of early failure. Overall mechanical failures were primarily
were constructed of Type I11 gold with acrylic veneers. responsible for a shorter than average life span.
Excluding extra-oral trauma, failure occurred in 12.3 Walton et aI.8 in 1986 published a study designed to
per cent of cases, of which the majority (8.3 per cent) were update the work of Schwartz et al. They examined 270
due to fracture of one sort or another. The absence of patients who presented themselves to a US Army dental
loose retainers in their study was attributed by the authors clinic for replacement of a failed fixed prosthesis.
to the exclusive use of full crowns as bridge retainers, and As in the earlier study only restorations requiring
the adherence to principles of preparation design and replacement were considered. The average life span for
retention. all the failed restorations was 8.3 years. Once again the
Glantz et ~ 1 examined
. ~ a random group of patients most frequent cause for failure was caries (22 per cent)
treated by private general dentists. They reported that, and this occurred on average after 10.9 years, a longer
after 5 years, 2 per cent of the fixed prosthetic restora- than average age. Porcelain failures (16 per cent) and
uncemented crowns (15.1 per cent) were the next most
tions had been lost and approximately 10 per cent of the
frequent causes of failure and, significantly, these occurred
restorations were faulty. The major problems identified
at a mean time of 5.7 and 5.8 years which represents the
were caries and overcontouring.
second (and third) shortest life span in the study. Porcelain
Ten years after insertion Karlsson4 examined 238 failure and loss of retention were the major causes of early
bridges of at least five units, made by a large number of failure.
private practitioners. Seventy-five per cent of the bridges As in the earlier study, Walton er aL8 found that mechan-
were constructed of gold alloy with acrylic resin veneers ical problems were almost exclusively responsible for a
and the rest were porcelain bonded to gold alloy. Although shorter than average service life in fixed prostheses.
93 per cent of the bridges were still in place, a high propor- However, unlike Schwartz et aL7 who found that mechan-
tion of these had problems and were in need of removal ical problems and oral disease contributed almost equally
or repair: 12.6 per cent of the bridges had a loose retainer, to the incidence of failures, the authors found in their
14.9 per cent of the abutment teeth had caries at the more recent study that mechanical failures outnumbered
margin, 7.5 per cent of the abutment teeth had a ‘filling’ failures due to oral disease by almost two and a half to one.
at the margin (indicating previous caries), and 13.1 per The shorter mean service life and the increased propor-
cent of the abutment teeth had a periapical lesion. tion of mechanical failures found by Walton et al. may,
Kar1sson5was able to re-examine 140 of the prostheses in part, have been a consequence of more frequent recall
after a further 4 years. Fourteen years after completion visits and earlier detection of problems, an overall reduc-
17 per cent of the bridges had been completely removed, tion in the incidence of caries in America, and an increase
3 per cent partly removed, and 5 per cent had uncemented in the use of porcelain and a corresponding increase in
retainers. Overall he recorded a failure rate of 26 per cent. mechanical problems associated with the use of this
However it is significant that ‘unsatisfactory restorations’ material.
and failures due to caries, periodontal disease and The mean service life of the failed prostheses in
endodontic problems were not included in the figures. ValderhaugV 15-year study was 10.5 years. Insufficient
In a 15-year clinical evaluation, Valderhaug6 was able retention was the major cause of failure (27 per cent)
to follow the outcome of a number of bridges made under followed by poor aesthetics (23 per cent) and caries (19
close supervision by senior students. All the bridges were per cent). Again, it was loss of retention which resulted
made of gold alloy with acrylic veneers, and constructed in a shorter than average service life (9 years) as compared
under identical conditions. Valderhaug observed a failure with caries (12 years) and poor aesthetics (14 years).
Australian Dental Journal 1994;39:3. 151
Table 2. Comparison of failure rates of Table 3. Relationship between dowel length
endodontically treated abutment teeth" and clinical success'
Restoration type 70 Failure Dowel length (as proportion of 70
crown length) Success
No crown 24.2
Crown 5.2 No dowel 89.8
Bridge abutment 10.2 114 75.0
Removable denture abutment 22.6 112 81.5
314 85.1
*From Sorensen and Martinoff." 414 97.5
1 114 100
1 112 100
Important considerations in fixed prosthodontic 2 100
treatment *From Sorensen and Martinoff.I2
Assessment and diagnosis
Functional loading and parafunction
than double the load was required to elicit pain from the
Although the type of opposing dentition (that is, fully
non-vital teeth. The authors postulated that protective
dentate or tooth supported prostheses, compared with
mechano-receptors are probably present within vital teeth
tissue borne removable prostheses) had little influence on
which are more responsive to bending loads than the
the rate of technical failures in one study,' Schwartz et
proprioceptive receptors in the periodontium.
al.' found that fixed prostheses opposed by a full denture
had the longest mean life span. In their study broken
Design considerations
joints, lost veneers or pontics, occlusal perforation and
loss of cementation occurred almost exclusively with Adequate space for good prosthetic design
natural opposing dentitions which they felt was an Adequate vertical space is necessary in the edentulous
indication of the greater stresses being delivered. area for artificial teeth of sufficient height and for a SUE-
Sorensen and MartinofPo found that the failure rate for cient thickness for the prosthetic materials to possess
endodontically treated teeth used as abutments depended rigidity and strength. Adequate occlusal clearance over
upon the type of restoration being supported (Table 2), tooth preparations is needed for sufficient thickness of
and hence the degree of loading being experienced. An restorative material to provide stiffness and prevent even-
abutment for a bridge is in general subjected to greater tual perforation during function.
loading, and more of the potentially harmful loads (that As outlined earlier, one of the major and most signifi-
is, non-axial), than a single crown abutment; a partial cant causes of fixed prosthodontic failure is the loss of
denture abutment is even more unfavourably loaded. re te n ti~ n .I +~
It is of paramount importance that the clin-
Patients with a tendency for parafunctional activity (for ical crown length of abutment teeth should be sufficient
example, bruxism, clenching) apply stresses to their denti- to allow for retentive tooth preparations.
tions with greater frequency, greater amplitude and longer Where space is inadequate it needs to be created. This
duration than is normally experienced. Restorations in may necessitate the reduction of over-erupted teeth,
these patients are consequently much more likely to increasing the patient's vertical dimension, surgical reduc-
experience problem^.^, tion of alveolar bone and soft tissue, and surgical
elongation of short abutment teeth.I6
Selection of teethhon-vital abutments
The fracture resistance of a tooth is determined by the Post and cores
bulk of remaining tooth structure.l2For instance, a thin Short posts and large diameter post holes predispose
tooth or one with a large or wide post hole is more likely to root fracture and should not be used. Post holes should
to fracture. A study of root resected teeth found that 38 be made with minimal loss of tooth structure as the first
per cent of such teeth failed within 10 years, although priority. At the same time, a post which is too thin at
interestingly 84 per cent of the failures occurred after 5 the coronal end may bend and lead to failure. Parallelism
years.13 Most of the failures were due to root fracture of the apical portion of the post is needed for increased
which is to be expected when the typically thin cross- retention; but coronally a flared root canal should not be
sectional width of many molar roots is considered. enlarged for the purpose of achieving parallel walls.
Numerous s t u d i e ~ ' .have
~ , ~ shown that the likelihood of In a clinical survey of failed post-retained crowns," 70
failure increases significantly when non-vital teeth are used per cent of the failures were caused by loss of retention.
as abutments. In one report on cantilever bridges, 2 per Although the greatest number of failures were found with
cent of the vital abutments fractured as compared with smooth, tapered cast posts it was the length rather than
40 per cent of the root-filled abutment^.'^ the shape of the cast post which was the significant factor;
Seeking an explanation for the high frequency of frac- 82 per cent of the failures had posts shorter than the
ture observed in root-filled teeth, Randow and GlantzIs clinical crown. Sorensen and MartinofP found a direct
carried out an experimental clinical study in which relationship between dowel length and clinical success
cantilever loads were applied to crowns both on vital teeth (Table 3 ) . A root-filled tooth with a post shorter than the
and on comparable root-filled teeth. It was found that more length of the clinical crown was found to be more likely
152 Australian Dental Journal 1994;39:3.
HCEMENT
BCAST POST

1 2 3 4
Fig. 3.-Loading in the centre of the beam causes flexure which has a
Fig. 1. -Four post-core designs subjected to loading. Design 2 was shown tendency to cause deformation at the abutment margins and places the
to be significantly more resistant to failure than the other designs. integrity of the cement seal at risk.
From Sorensen and Engelman." From Caputo and Standlee."

to fail than a tooth with no post. Optimal success rates a 60 degree bevel at the crown margin, or at the tooth-
were observed with long posts. core junction, was ineffective.
In a comparison of various post-core designs (Fig. l),
Sorensen and Engelman" found that teeth with cast Metal frameworks
tapered post-cores which were maximally adapted to the Fixed prosthodontic metal frameworks, as with any
root canal exhibited failure loads almost double those of metal beam, will flex when subjected to loading (Fig. 3).
the teeth with the other post-core designs. However, when Laboratory experimentsz0indicate that such flexure may
failure occurred, these teeth fractured and were unsal- cause deformation near the abutment margins and place
vagable whereas failure of teeth with parallel-sided posts great stresses on the sealing cement. This may ultimately
often involved less damage to tooth structure. lead to disruption of the cement layer and loss of cemen-
In a further study,I9 the same authors found that 1 mm tation. Consequently, metal frameworks must be
of coronal tooth structure above the crown margin (that sufficiently rigid to withstand such deformation.
is, encircling at least 1 mm of sound dentine) almost The flexure of a beam is proportional to the third power
doubled the fracture resistance (Fig. 2). On the other hand, of the beam span; therefore, limiting flexure becomes
increasingly more difficult as the space between abutment
teeth increases.z' There is, in these cases, an even greater
need for the selection of materials with adequate physical
properties (namely a high modulus of elasticity) and the
provision of a sufficient thickness of metal. The added
thickness is most needed in the direction of load applica-
tion, that is, occluso-gingivally.1. l 6
In ceramo-metal restorations deformation of the metal
can lead to debonding and fracture of the porcelain, hence
there is an added requirement for rigidity. Possibly of even
greater importance in the selection of a porcelain fused
to metal alloy is its ability to be effectively oxidized and
achieve optimum bonding of the porcelain veneering
material.
Fosterz2found that precious metal (that is, gold-based)
bridges had a significantly longer mean service life than
semi- or non-precious alloy bridges (10 years versus 3.9
years). The author felt that the unacceptably poor result
for semi- and non-precious alloys may be a reflection of
difficulties with bonding and incorrect oxidation encoun-
tered with these materials. Metal frameworks must also
be designed to avoid large unsupported sections of
porcelain which may otherwise f r a c t ~ r e . ~ , '
Fig. 2. -Encircling one millimetre of axial tooth Casting imperfections, porosity, poor or small solder
structure with the crown will significantly increase
the fracture resistance of the restored tooth.
joints and small connectors may all predispose to frac-
From Sorensen and Engelman." ture in a framework. Eighty-three per cent of fractures
Australian Dental Journal 1994;39:3. 153
the abutments, increased parallelism between abutments
and an increased thickness of metal to resist bending.
Reuter and Brose2found a higher incidence of failure with
long span bridges. Schwartz et a1.’ found that most long
span bridges had a markedly shorter than average life span
(8.6 years compared with 11.2 years for all bridges).
Interestingly, the exceptions to this were 6-unit bridges
from canine to canine which proved to have the longest
mean life span before failure (15.1 years). The results
reported by Walton et a1.* were similar.
Reuter and Brose2also found a significantly higher rate
Fig. 4.-A, Force applied outside the centre ofrotation ofabutments produces of failure with bridges that extended around the corner
a lifting force at the opposite end of the bridge. B, Force applied between
centres of rotation of abutments produces a seating force on both retainers. of the arch to include both anterior and posterior teeth.
From Jacobi R er aLZ4 Whereas 8.3 per cent of their posterior bridges failed, and
14.7 per cent of their anterior bridges failed, the authors
found 58.8 per cent of their combined anterior-posterior
in cantilevered bridges occur on the mesial of the most bridges became failures.
distal abutment toothy9hence this connector should be
strengthened routinely. Cantilever designs
An impact falling between the centres of rotation of the
Retainer selection abutment teeth in a fured prosthesis has the principal effect
It is recognized that the rigidity of an intact tube is much of seating the bridge rather than displacing it (Fig. 4).
greater than that of a tube which has been cut open. On the other hand, a force applied outside the centre of
Similarly, a full crown is much more resistant to defor- rotation of an abutment tooth will cause it to tilt and there
mation (and cement failure) than a three-quarter or partial will be a resulting force exerted on the distant retainer
crown. tending to lift it off the abutment tooth leading to early
Robertsz3 examined 1046 bridges made at Eastman failure. The importance of the fulcrum and its position
Dental Hospital between 1952 and 1964 to determine the relative to the site of load application is highlightea by
suitability or otherwise of different types of bridge the results of an experiment performed by Jacobi et aLZ4
retainers for various types of bridges. Although there have They observed that when the impacts fell between the
been a number of advances since this study was begun, centres of rotation of the abutments the retention time
the fundamental nature of crown and bridgework has not of the cemented bridges was more than 24 times greater
altered. The study is primarily concerned with matters than when they fell outside. In some situations longevity
of design, and the conclusions drawn regarding the rela- was increased 130 fold.
tive failure rates of various bridge designs or retainer types, Therefore, it would seem desirable in fixed bridge
when compared with one another, are still likely to be designs to minimize the application of loads outside the
valid. long axes of the abutment teeth wherever possible.
Robertsz3found that fill crowns were considerably more However cantilever bridges, by design, cannot avoid such
successful than three-quarter crowns as major retainers loads. Therefore, exceptionally good retention is needed
(that is, those retainers rigidly attached to a pontic). Inlays, for the retainer that is firthermost from the eccentric load.
pinlays and post-crowns had high failure rates. He In an epidemiological study of 274 fEed prostheses made
concluded that in bridges rigidly fixed at both ends, only 6 or 7 years earlier, Randow et a1.9compared three groups
full crowns should be used as retainers. In fixed-movable of bridges: bridges with a distal abutment tooth, bridges
designs a three-quarter crown might be adequate as the with a single cantilever pontic, and bridges with double
major retainer, although slightly less reliable. cantilever pontics. They found that the frequency of tech-
A minor retainer is defined as the one which is not nical failures (that is, fractures of prostheses, of abutments,
rigidly attached to a pontic in a stress-broken design (that and loss of retention) was directly related to the degree
is, the retainer incorporating the dovetail or slot). Roberts of cantilever extension. The rate of failures increased with
concluded that for use as minor retainers both full crowns time, and this increase was much more severe with
and three-quarter crowns were extremely successful. multiple cantilever pontics. These results were mirrored
MOD, Class I1 and Class I11 inlays could be considered by Karlsson’ who, after 14 years, found a failure rate of
for use, but are much less reliable. 12 per cent for bridges with an abutment at either end
as compared with 33 per cent in designs with cantilever
Long spans and complex designs pontics.
Failures are more likely to occur with long spans (more On the other hand, cantilevered fixed prostheses
than 5 or 6 units) and with complex designs. Nymen and compared favourably when compared with removable
Lindhe’ found that long spans and long cantilever designs partial dentures in a 5-year longitudinal study with two
were more prone to loss of retention. They stated that similar groups of patient^.'^ Although technical failures
in these cases there was a need for increased retention on occurred with 19 per cent of the bridges, most could be
154 Australian Dental Journal 1994;39:3.
Fig. 6 . -A stress-broken bridge design, utilizing shorter segments which
are not rigidly connected prevents the central abutment from acting as a
fulcrum.
Fig. 5.-An intermediate abutment tooth in a fully fixed design acts as a From Caputo and Standlee.”
fulcrum. Loads applied on one side cause lifting of the bridge retainer at
the opposite end.
From Caputo and Standlee.”
Foster” found a significant correlation between the life
span of failed bridges and the number of retainers in their
design: 7 years for bridges with one or two retainers as
easily recemented. However, in the removable partial compared with 4 years when three or more retainers were
denture group caries was six times more prevalent, and involved.
there was a pronounced deterioration in occlusal stability, Multi-abutment bridges are more prone to failure
in maxillary denture stability, and an increased soreness because the alignment of multiple tooth preparations is
of the anterior edentulous maxillary ridge. difficult and may result in excessive taper which will
Reichen-Graden and LangZ6 found no differences jeopardize retention, they are technically more difficult
between the rates of technical failures for conventional to fabricate and fit with accuracy (both for the technician
and cantilever bridges after 4 to 8 years. And Laurel1 et and the dentist), and because of the presence of pier
al., l6 in a study of 36 cross-arch prostheses with multiple abutments.
cantilevered pontics followed over 5 to 12 years, were able When more than two abutments are rigidly joined, the
to limit their failures to 8 per cent. In both of these studies, middle or pier abutment(s) will act as a fulcrum (Fig. 5).
there was a strict adherence to the principles of optimal The end result is frequently a loss of retention on the
retention, thick framework dimensions for rigidity and terminal abutment. The terminal abutments are report-
specific occlusal design criteria. edly the ones most prone to failure.’.’ A design more likely
to succeed is one which involves shorter segments that
Splinting and multiple abutments utilize non-rigid connectors in order to circumvent the
Fixed bridges present certain problems by virtue of the creation of a fulcrum (Fig. 6).
fact that more than one unit is involved. In these cases In view of all of the foregoing, it would seem prudent
the application of force to the restoration will involve the to refrain from rigidly splinting teeth wherever possible
transmission of forces indirectly to the various abutment and, when unavoidable, to ensure that the abutment teeth
teeth and supporting structures, with the direction of the offer exceptionally good retention.
original force being altered as it is transmitted. This in
turn will influence the resistance to displacement and ulti- Discussion
mate survival time of these restorations. Fixed prosthodontic treatment does not last a lifetime.
RobertsYz3 in comparisons between the failure rates of It represents a mechanical repair in a changing and
fixed, stress-broken and cantilever bridge designs, found demanding biological environment. The longevity of a
that designs which were fixed at both ends were much restoration is dependent on a great many factors including
more prone to loss of retention and failure. He concluded the type and design of the prosthesis, the degree of func-
that a bridge rigidly fixed at both ends places much higher tional and parafunctional loading, the structural integrity
demands on the retention provided by the abutment teeth and biological status of the supporting teeth and tissues,
than a bridge which is movable at one end. appropriate maintenance and home care, and the precision
Schwartz et aL7 found that a two-unit bridge with a with which the technical and clinical work has been carried
single abutment supporting a cantilever pontic lasted out.
longer on average than a two-unit prosthesis involving It is difficult to state, definitively, what might be consi-
two splinted abutments. The authors suggested that the dered a satisfactory lifetime for a fixed prosthesis.
‘temptation to use splinted retainers needlessly should be Practitioners must make their own assessment based upon
tempered by the knowledge of the added risk each abut- the information presented. In favourable circumstances,
ment brings to the prosthesis’. in a majority of cases, it would appear reasonable to expect
Australian Dental Journal 1994;39:3. 155
a well designed and constructed prosthesis to survive ten 11. Coornaert J, Adriaens P, De Boever J. Long-term clinical study of
porcelain-fused-to-gold restorations. J Prosthet Dent 1984;5 1:338-42.
years or more.
12. Sorensen JA, Martinoff JT. Clinically significant factors in dowel design.
J Prosthet Dent 1984;52:28-35.
Summary
13. Langer B, Stein SD, Wagenberg B. An evaluation of root resections.
Other than caries, the predominant reasons for failure A ten-year study. J Periodontol 1981;52:719-22.
are loss of retention, porcelain failure, and fracture of the 14. Landolt A, Lang NP. Results and failures with extension bridges -
bridge or abutment tooth. It is recommended that, a clinical and roentgenological follow-up study of free end bridges.
whenever possible, practitioners should: Schweiz Monatsschr Zahnmed 1988;98:239-44.
1. Maximize retention. 15. Randow K, Glantz PO. On cantilever loading of vital and non-vital
teeth. An experimental clinical study. Acta Odontol Scand
2. Maximize the strength of the metal framework. 1986;44:271-7.
3. Use only full crown retainers when rigidly joined 16. Laurel1 L, Lundgren D, Falk H, Hugoson A. Long-term prognosis of
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4. Minimize the use of splinted abutments. 1991;66:545-52.
17. Lewis R, Smith BGN. A clinical survey of failed post retained crowns.
5. Avoid short posts in non-vital teeth and thin or Br Dent J 1988;165:95-7.
weakened teeth.
18. Sorensen JA, Engelman MJ. Effect of post adaptation on fracture
6 . Beware of non-vital abutment teeth. resistance of endodontically treated teeth. J Prosthet Dent
7. Beware of load application outside the long axes of 1990;64:4 19-24.
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8. Beware of long spans or complex designs.
20. Goldstein GR, Wesson A, Schweitzer K, Cutler B. Flexion charac-
9. Beware of patients with parafunction. teristics of four-unit futed partial denture frameworks using holographic
interferometry. J Prosthet Dent 1992;67:609-13.
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