Australian Dental Journal 1994;39(3):150-6
Fixed prosthodontic failure.
A review and discussion of important aspects
Alex Selby, BDS, MDS(Syd)
Abstract
In order to justify the time and expense involved in
complex restorative treatment there is an expecta-
tion of a favourable result and long-term success.
Longevity in fixed prosthodontics is not only depen-
dent upon the precision and skill with which the work
is carried out, but also to a large degree upon a
proper assessment and diagnosis and the utilization
and implementation of valid principles of design.
This paper reviews the literature in an attempt to
determine the incidence of failure and the reasons
for, and types of, failures that occur. There is a
consideration of some factors important in pre-
operative assessment and a detailed discussion of
various aspects of design for fixed prosthodontic
restorations.
Key words: Fixed prosthodontic, review, failure.
(Received for publication August 1992. Revised November
1992. Accepted January 1993.)
Introduction
Because the tolerances are minute and the field of oper-
ation restricted, and because restorations must survive in
a demanding biological environment over which there is
little control, the practice of fixed prosthodontics will
always yield a certain percentage of unsatisfactory results.
Yet one of the most frustrating and demoralizing aspects
of dental practice is to be confronted by the failure of work,
despite careful planning, meticulous attention to detail
and the application of a great deal of time and effort.
A consideration of the nature and frequency of failures
and an examination of the circumstances that lead to
failure may help identify potential problems and provide
a basis from which to make more reliable judgments with
regard to treatment planning.
The incidence of failure
Theories and principles related to the practice of fixed
prosthodontics have to a large degree been obtained by
reasoning, clinical observations, anecdotal reports and
extrapolation from laboratory experiments. However, the
150
results of laboratory studies cannot always be accepted
without question; in v i m experiments may not always
reflect the clinical circumstances or outcome. Neverthe-
less, with judicious interpretation non-clinical studies offer
insight into anticipated clinical behaviour.
A search of the dental literature on fixed prosthodontics
reveals very few longitudinal or cross-sectional clinical
studies. Comparisons of the available reports are difficult
because the published papers often vary with respect to
the nature and design of their study or the material being
examined. For instance, the prosthodontic treatment may
have been carried out by private general dentists, by senior
undergraduate students, or within a specialist clinic; and
by numerous clinicians or by the one operator. Further-
more the authors often vary in their definition of failure.
Failure of a fixed prosthesis can occur in many ways.
The reasons for failure may, for the purposes of discus-
sion, be divided into biological problems and mechanical
problems; they are listed in Table 1. Whereas mechan-
ical problems are, in general, more directly under the
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
biological problems may be a consequence of the treat-
ment procedures (for example, pulpal problems) or of the
restorations themselves (for example, caries), if they are
deficient in execution or design.
Nyman and Lindhe' presented a study of 251 patients
with advanced periodontal breakdown who, following
comprehensive periodontal treatment, received 332 fixed
prostheses and were followed for 5 to 8 years. Their
patients were a very select group with marked bone loss
and complex prostheses, often with very long spans and
long cantilevered sections. T o their advantage, the abut-
ment teeth had long clinical crowns, facilitating the
development of good retention form in the abutment
preparations, and the metal frameworks were able to be
made correspondingly thicker to provide greater strength
in the prosthesis.
Periodontal health was maintained in all cases; however,
7.8 per cent of the bridges experienced failures of a
technical nature. The failures were due to loss of reten-
tion (3.3 per cent), fracture of the bridgework (2.1 per
cent), and fracture of the abutments (2.4 per cent).
Australian Dental Journal 1994;39:3.
Table 1. Reasons for failure of fixed prostheses
Biological problems
Caries
Periodontal disease
Endodontic or periapical problems
Mechanical problems
Loss of retention
Fracture or loss of porcelain
Wear or loss of acrylic veneer
Wear or perforation of gold
Fracture of metal framework
Fracture of solder joints
Fracture of abutment tooth or root
Defective margins
Poor contour
Poor aesthetics
Reuter and Brose2 reviewed 121 bridges constructed
over an 11-year period, made by the one clinician in a
private practice. The average review period was 4.9 years
from the time of construction. Ninety-one per cent of the
bridges were porcelain fused to gold and the remainder
were constructed of Type I11 gold with acrylic veneers.
Excluding extra-oral trauma, failure occurred in 12.3
per cent of cases, of which the majority (8.3 per cent) were
due to fracture of one sort or another. The absence of
loose retainers in their study was attributed by the authors
to the exclusive use of full crowns as bridge retainers, and
the adherence to principles of preparation design and
retention.
Glantz et ~ 1 examined
. ~ a random group of patients
treated by private general dentists. They reported that,
after 5 years, 2 per cent of the fixed prosthetic restora-
tions had been lost and approximately 10 per cent of the
restorations were faulty. The major problems identified
were caries and overcontouring.
Ten years after insertion Karlsson4 examined 238
bridges of at least five units, made by a large number of
private practitioners. Seventy-five per cent of the bridges
were constructed of gold alloy with acrylic resin veneers
and the rest were porcelain bonded to gold alloy. Although
93 per cent of the bridges were still in place, a high propor-
tion of these had problems and were in need of removal
or repair: 12.6 per cent of the bridges had a loose retainer,
14.9 per cent of the abutment teeth had caries at the
margin, 7.5 per cent of the abutment teeth had a ‘filling’
at the margin (indicating previous caries), and 13.1 per
cent of the abutment teeth had a periapical lesion.
Kar1sson5was able to re-examine 140 of the prostheses
after a further 4 years. Fourteen years after completion
17 per cent of the bridges had been completely removed,
3 per cent partly removed, and 5 per cent had uncemented
retainers. Overall he recorded a failure rate of 26 per cent.
However it is significant that ‘unsatisfactory restorations’
and failures due to caries, periodontal disease and
endodontic problems were not included in the figures.
In a 15-year clinical evaluation, Valderhaug6 was able
to follow the outcome of a number of bridges made under
close supervision by senior students. All the bridges were
made of gold alloy with acrylic veneers, and constructed
under identical conditions. Valderhaug observed a failure
Australian Dental Journal 1994;39:3.
rate of 4 per cent after 5 years, 12 per cent after 10 years,
and 32 per cent after 15 years.
It becomes apparent with any discussion on failures of
treatment that in order to maintain a balanced outlook
one must also consider longevity of service. For example
a restoration that becomes unserviceable after 30 years
of service cannot truly be considered a failure.
Schwartz et aI.’ examined 406 patients with failed
crowns and bridges in order to survey the reasons for
failure and the life span of the restorations that had failed.
The average life span for all the failed restorations in their
study was 10.3 years; 20 per cent failed within 3 years,
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,
which is a longer life than the average age at which failure
occurred. The second most frequent cause for failure was
uncemented crowns (12.1 per cent) and this occurred, on
average, after only 6.8 years. This was a significant cause
of early failure. Overall mechanical failures were primarily
responsible for a shorter than average life span.
Walton et aI.8 in 1986 published a study designed to
update the work of Schwartz et al. They examined 270
patients who presented themselves to a US Army dental
clinic for replacement of a failed fixed prosthesis.
As in the earlier study only restorations requiring
replacement were considered. The average life span for
all the failed restorations was 8.3 years. Once again the
most frequent cause for failure was caries (22 per cent)
and this occurred on average after 10.9 years, a longer
than average age. Porcelain failures (16 per cent) and
uncemented crowns (15.1 per cent) were the next most
frequent causes of failure and, significantly, these occurred
at a mean time of 5.7 and 5.8 years which represents the
second (and third) shortest life span in the study. Porcelain
failure and loss of retention were the major causes of early
failure.
As in the earlier study, Walton er aL8 found that mechan-
ical problems were almost exclusively responsible for a
shorter than average service life in fixed prostheses.
However, unlike Schwartz et aL7 who found that mechan-
ical problems and oral disease contributed almost equally
to the incidence of failures, the authors found in their
more recent study that mechanical failures outnumbered
failures due to oral disease by almost two and a half to one.
The shorter mean service life and the increased propor-
tion of mechanical failures found by Walton et al. may,
in part, have been a consequence of more frequent recall
visits and earlier detection of problems, an overall reduc-
tion in the incidence of caries in America, and an increase
in the use of porcelain and a corresponding increase in
mechanical problems associated with the use of this
material.
The mean service life of the failed prostheses in
ValderhaugV 15-year study was 10.5 years. Insufficient
retention was the major cause of failure (27 per cent)
followed by poor aesthetics (23 per cent) and caries (19
per cent). Again, it was loss of retention which resulted
in a shorter than average service life (9 years) as compared
with caries (12 years) and poor aesthetics (14 years).
151
Table 2. Comparison of failure rates of
endodontically treated abutment teeth"
Restoration type 70 Failure
No crown 24.2
Crown 5.2
Bridge abutment 10.2
Removable denture abutment 22.6
*From Sorensen and Martinoff."
Important considerations in fixed prosthodontic
treatment
Assessment and diagnosis
Functional loading and parafunction
Although the type of opposing dentition (that is, fully
dentate or tooth supported prostheses, compared with
tissue borne removable prostheses) had little influence on
the rate of technical failures in one study,' Schwartz et
al.' found that fixed prostheses opposed by a full denture
had the longest mean life span. In their study broken
joints, lost veneers or pontics, occlusal perforation and
loss of cementation occurred almost exclusively with
natural opposing dentitions which they felt was an
indication of the greater stresses being delivered.
Sorensen and MartinofPo found that the failure rate for
endodontically treated teeth used as abutments depended
upon the type of restoration being supported (Table 2),
and hence the degree of loading being experienced. An
abutment for a bridge is in general subjected to greater
loading, and more of the potentially harmful loads (that
is, non-axial), than a single crown abutment; a partial
denture abutment is even more unfavourably loaded.
Patients with a tendency for parafunctional activity (for
example, bruxism, clenching) apply stresses to their denti-
tions with greater frequency, greater amplitude and longer
duration than is normally experienced. Restorations in
these patients are consequently much more likely to
experience problem^.^,
Selection of teethhon-vital abutments
The fracture resistance of a tooth is determined by the
bulk of remaining tooth structure.l2For instance, a thin
tooth or one with a large or wide post hole is more likely
to fracture. A study of root resected teeth found that 38
per cent of such teeth failed within 10 years, although
interestingly 84 per cent of the failures occurred after 5
years.13 Most of the failures were due to root fracture
which is to be expected when the typically thin cross-
sectional width of many molar roots is considered.
Numerous s t u d i e ~ ' .have
~ , ~ shown that the likelihood of
failure increases significantly when non-vital teeth are used
as abutments. In one report on cantilever bridges, 2 per
cent of the vital abutments fractured as compared with
40 per cent of the root-filled abutment^.'^
Seeking an explanation for the high frequency of frac-
ture observed in root-filled teeth, Randow and GlantzIs
carried out an experimental clinical study in which
cantilever loads were applied to crowns both on vital teeth
and on comparable root-filled teeth. It was found that more
152
Table 3. Relationship between dowel length
and clinical success'
Dowel length (as proportion of 70
crown length) Success
No dowel 89.8
114 75.0
112 81.5
314 85.1
414 97.5
1 114 100
1 112 100
2 100
*From Sorensen and Martinoff.I2
than double the load was required to elicit pain from the
non-vital teeth. The authors postulated that protective
mechano-receptors are probably present within vital teeth
which are more responsive to bending loads than the
proprioceptive receptors in the periodontium.
Design considerations
Adequate space for good prosthetic design
Adequate vertical space is necessary in the edentulous
area for artificial teeth of sufficient height and for a SUE-
cient thickness for the prosthetic materials to possess
rigidity and strength. Adequate occlusal clearance over
tooth preparations is needed for sufficient thickness of
restorative material to provide stiffness and prevent even-
tual perforation during function.
As outlined earlier, one of the major and most signifi-
cant causes of fixed prosthodontic failure is the loss of
re te n ti~ n .I +~
It is of paramount importance that the clin-
ical crown length of abutment teeth should be sufficient
to allow for retentive tooth preparations.
Where space is inadequate it needs to be created. This
may necessitate the reduction of over-erupted teeth,
increasing the patient's vertical dimension, surgical reduc-
tion of alveolar bone and soft tissue, and surgical
elongation of short abutment teeth.I6
Post and cores
Short posts and large diameter post holes predispose
to root fracture and should not be used. Post holes should
be made with minimal loss of tooth structure as the first
priority. At the same time, a post which is too thin at
the coronal end may bend and lead to failure. Parallelism
of the apical portion of the post is needed for increased
retention; but coronally a flared root canal should not be
enlarged for the purpose of achieving parallel walls.
In a clinical survey of failed post-retained crowns," 70
per cent of the failures were caused by loss of retention.
Although the greatest number of failures were found with
smooth, tapered cast posts it was the length rather than
the shape of the cast post which was the significant factor;
82 per cent of the failures had posts shorter than the
clinical crown. Sorensen and MartinofP found a direct
relationship between dowel length and clinical success
(Table 3 ) . A root-filled tooth with a post shorter than the
length of the clinical crown was found to be more likely
Australian Dental Journal 1994;39:3.
 HCEMENT
BCAST POST
1 2 3 4
Fig. 1. -Four post-core designs subjected to loading. Design 2 was shown
to be significantly more resistant to failure than the other designs.
From Sorensen and Engelman."
to fail than a tooth with no post. Optimal success rates
were observed with long posts.
In a comparison of various post-core designs (Fig. l),
Sorensen and Engelman" found that teeth with cast
tapered post-cores which were maximally adapted to the
root canal exhibited failure loads almost double those of
the teeth with the other post-core designs. However, when
failure occurred, these teeth fractured and were unsal-
vagable whereas failure of teeth with parallel-sided posts
often involved less damage to tooth structure.
In a further study,I9 the same authors found that 1 mm
of coronal tooth structure above the crown margin (that
is, encircling at least 1 mm of sound dentine) almost
doubled the fracture resistance (Fig. 2). On the other hand,
Fig. 2. -Encircling one millimetre of axial tooth
structure with the crown will significantly increase
the fracture resistance of the restored tooth.
From Sorensen and Engelman."
Australian Dental Journal 1994;39:3.
Fig. 3.-Loading in the centre of the beam causes flexure which has a
tendency to cause deformation at the abutment margins and places the
integrity of the cement seal at risk.
From Caputo and Standlee."
a 60 degree bevel at the crown margin, or at the tooth-
core junction, was ineffective.
Metal frameworks
Fixed prosthodontic metal frameworks, as with any
metal beam, will flex when subjected to loading (Fig. 3).
Laboratory experimentsz0indicate that such flexure may
cause deformation near the abutment margins and place
great stresses on the sealing cement. This may ultimately
lead to disruption of the cement layer and loss of cemen-
tation. Consequently, metal frameworks must be
sufficiently rigid to withstand such deformation.
The flexure of a beam is proportional to the third power
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 . ~ , '
Casting imperfections, porosity, poor or small solder
joints and small connectors may all predispose to frac-
ture in a framework. Eighty-three per cent of fractures
153

Fig. 4.-A, Force applied outside the centre ofrotation ofabutments produces
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.
From Jacobi R er aLZ4
in cantilevered bridges occur on the mesial of the most
distal abutment toothy9hence this connector should be
strengthened routinely.
Retainer selection
It is recognized that the rigidity of an intact tube is much
greater than that of a tube which has been cut open.
Similarly, a full crown is much more resistant to defor-
mation (and cement failure) than a three-quarter or partial
crown.
Robertsz3 examined 1046 bridges made at Eastman
Dental Hospital between 1952 and 1964 to determine the
suitability or otherwise of different types of bridge
retainers for various types of bridges. Although there have
been a number of advances since this study was begun,
the fundamental nature of crown and bridgework has not
altered. The study is primarily concerned with matters
of design, and the conclusions drawn regarding the rela-
tive failure rates of various bridge designs or retainer types,
when compared with one another, are still likely to be
valid.
Robertsz3found that fill crowns were considerably more
successful than three-quarter crowns as major retainers
(that is, those retainers rigidly attached to a pontic). Inlays,
pinlays and post-crowns had high failure rates. He
concluded that in bridges rigidly fixed at both ends, only
full crowns should be used as retainers. In fixed-movable
designs a three-quarter crown might be adequate as the
major retainer, although slightly less reliable.
A minor retainer is defined as the one which is not
rigidly attached to a pontic in a stress-broken design (that
is, the retainer incorporating the dovetail or slot). Roberts
concluded that for use as minor retainers both full crowns
and three-quarter crowns were extremely successful.
MOD, Class I1 and Class I11 inlays could be considered
for use, but are much less reliable.
Long spans and complex designs
Failures are more likely to occur with long spans (more
than 5 or 6 units) and with complex designs. Nymen and
Lindhe’ found that long spans and long cantilever designs
were more prone to loss of retention. They stated that
in these cases there was a need for increased retention on
154
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
of failure with bridges that extended around the corner
of the arch to include both anterior and posterior teeth.
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
bridges became failures.
Cantilever designs
An impact falling between the centres of rotation of the
abutment teeth in a fured prosthesis has the principal effect
of seating the bridge rather than displacing it (Fig. 4).
On the other hand, a force applied outside the centre of
rotation of an abutment tooth will cause it to tilt and there
will be a resulting force exerted on the distant retainer
tending to lift it off the abutment tooth leading to early
failure. The importance of the fulcrum and its position
relative to the site of load application is highlightea by
the results of an experiment performed by Jacobi et aLZ4
They observed that when the impacts fell between the
centres of rotation of the abutments the retention time
of the cemented bridges was more than 24 times greater
than when they fell outside. In some situations longevity
was increased 130 fold.
Therefore, it would seem desirable in fixed bridge
designs to minimize the application of loads outside the
long axes of the abutment teeth wherever possible.
However cantilever bridges, by design, cannot avoid such
loads. Therefore, exceptionally good retention is needed
for the retainer that is firthermost from the eccentric load.
In an epidemiological study of 274 fEed prostheses made
6 or 7 years earlier, Randow et a1.9compared three groups
of bridges: bridges with a distal abutment tooth, bridges
with a single cantilever pontic, and bridges with double
cantilever pontics. They found that the frequency of tech-
nical failures (that is, fractures of prostheses, of abutments,
and loss of retention) was directly related to the degree
of cantilever extension. The rate of failures increased with
time, and this increase was much more severe with
multiple cantilever pontics. These results were mirrored
by Karlsson’ who, after 14 years, found a failure rate of
12 per cent for bridges with an abutment at either end
as compared with 33 per cent in designs with cantilever
pontics.
On the other hand, cantilevered fixed prostheses
compared favourably when compared with removable
partial dentures in a 5-year longitudinal study with two
similar groups of patient^.'^ Although technical failures
occurred with 19 per cent of the bridges, most could be
Australian Dental Journal 1994;39:3.

Fig. 5.-An intermediate abutment tooth in a fully fixed design acts as a
fulcrum. Loads applied on one side cause lifting of the bridge retainer at
the opposite end.
From Caputo and Standlee.”
easily recemented. However, in the removable partial
denture group caries was six times more prevalent, and
there was a pronounced deterioration in occlusal stability,
in maxillary denture stability, and an increased soreness
of the anterior edentulous maxillary ridge.
Reichen-Graden and LangZ6 found no differences
between the rates of technical failures for conventional
and cantilever bridges after 4 to 8 years. And Laurel1 et
al., l6 in a study of 36 cross-arch prostheses with multiple
cantilevered pontics followed over 5 to 12 years, were able
to limit their failures to 8 per cent. In both of these studies,
there was a strict adherence to the principles of optimal
retention, thick framework dimensions for rigidity and
specific occlusal design criteria.
Splinting and multiple abutments
Fixed bridges present certain problems by virtue of the
fact that more than one unit is involved. In these cases
the application of force to the restoration will involve the
transmission of forces indirectly to the various abutment
teeth and supporting structures, with the direction of the
original force being altered as it is transmitted. This in
turn will influence the resistance to displacement and ulti-
mate survival time of these restorations.
RobertsYz3 in comparisons between the failure rates of
fixed, stress-broken and cantilever bridge designs, found
that designs which were fixed at both ends were much
more prone to loss of retention and failure. He concluded
that a bridge rigidly fixed at both ends places much higher
demands on the retention provided by the abutment teeth
than a bridge which is movable at one end.
Schwartz et aL7 found that a two-unit bridge with a
single abutment supporting a cantilever pontic lasted
longer on average than a two-unit prosthesis involving
two splinted abutments. The authors suggested that the
‘temptation to use splinted retainers needlessly should be
tempered by the knowledge of the added risk each abut-
ment brings to the prosthesis’.
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.
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
compared with 4 years when three or more retainers were
involved.
Multi-abutment bridges are more prone to failure
because the alignment of multiple tooth preparations is
difficult and may result in excessive taper which will
jeopardize retention, they are technically more difficult
to fabricate and fit with accuracy (both for the technician
and the dentist), and because of the presence of pier
abutments.
When more than two abutments are rigidly joined, the
middle or pier abutment(s) will act as a fulcrum (Fig. 5).
The end result is frequently a loss of retention on the
terminal abutment. The terminal abutments are report-
edly the ones most prone to failure.’.’ A design more likely
to succeed is one which involves shorter segments that
utilize non-rigid connectors in order to circumvent the
creation of a fulcrum (Fig. 6).
In view of all of the foregoing, it would seem prudent
to refrain from rigidly splinting teeth wherever possible
and, when unavoidable, to ensure that the abutment teeth
offer exceptionally good retention.
Discussion
Fixed prosthodontic treatment does not last a lifetime.
It represents a mechanical repair in a changing and
demanding biological environment. The longevity of a
restoration is dependent on a great many factors including
the type and design of the prosthesis, the degree of func-
tional and parafunctional loading, the structural integrity
and biological status of the supporting teeth and tissues,
appropriate maintenance and home care, and the precision
with which the technical and clinical work has been carried
out.
It is difficult to state, definitively, what might be consi-
dered a satisfactory lifetime for a fixed prosthesis.
Practitioners must make their own assessment based upon
the information presented. In favourable circumstances,
in a majority of cases, it would appear reasonable to expect
155
a well designed and constructed prosthesis to survive ten
years or more.
Summary
Other than caries, the predominant reasons for failure
are loss of retention, porcelain failure, and fracture of the
bridge or abutment tooth. It is recommended that,
whenever possible, practitioners should:
1. Maximize retention.
2. Maximize the strength of the metal framework.
3. Use only full crown retainers when rigidly joined
to other parts of the prosthesis.
4. Minimize the use of splinted abutments.
5. Avoid short posts in non-vital teeth and thin or
weakened teeth.
6 . Beware of non-vital abutment teeth.
7. Beware of load application outside the long axes of
abutment teeth and of cantilever designs.
8. Beware of long spans or complex designs.
9. Beware of patients with parafunction.
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Address for correspondenceheprints:
A. Selby,
Suite 111, 1 lth Floor,
183 Macquarie Street,
Sydney, New South Wales 2000.
Australian Dental Journal 1994;39:3