Journal of Dental Herald

www.dherald.in Journal of Dental Herald

(April 2014) Issue:2, Vol.:1
E ISSN No. : 2348 – 1331
P ISSN No. : 2348 – 134X
A Review
Abutment Evaluation – A Boon To Success Of Fixed Partial Denture
Sharma Sumeet1, Sethuraman Rajesh2, Singh Harvinder3, Singh Sarbjeet4, Wazir Dev Nikhil5
1
Senior lecturer, Department of Prosthodontics, Institute of Dental Sciences, Sehora, Jammu, India.
2
Professor, Department of Prosthodontics, K.M. Shah Dental College & Hospital, Vadodara, India.
3
Professor, Department of Prosthodontics,Institute of Dental Sciences, Sehora, Jammu, India.
4
Reader, Department of Oral Medicine & Radiology, Institute of Dental Sciences, Sehora, Jammu, India.
5
Professor & HOD, Department of Conservative & Endodontic, Institute of Dental Sciences, Sehora, Jammu, India.
Abstract
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper
materials, inadequate tooth preparation, and faculty fabrication. Of particular concern to dentists is the selection of teeth for abutment. They must
recognize the force developed by the oral mechanism, and the resistance of the tooth and its supporting structures to them.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Through knowledge of anatomy, ceramics, the
chemistry and physics of dental materials, metallurgy, periodontics, phonetics, physiology, radiology and the mechanics of oral function is
fundamental1. This article review diagnostic procedures and requisities for the selection of abutments.
Key Words
Biomechanics, FPD, Pontics, Retainer, Span length, Clinical crown, Anatomical crown.

Introduction double as an FPD retainer. If several abutments in one arch

Fixed prosthodontic treatment can range from the restoration
of a single tooth to the rehabilitation of the entire occlusion.
Single teeth can be restored to full function, and improvement
in cosmetic effect can be achieved. Missing teeth can be
replaced with prostheses that will improve patient comfort and
masticatory efficiency, maintain the health and integrity of the
dental arches, and, in many instances, elevates the patient’s
self-image.
Every restoration must be able to withstand the constant
occlusal forces to which it is subjected. This is to particular
significance when designing and fabricating a fixed partial
denture, since the forces that would normally be absorbed by
the missing tooth are transmitted, through the pontic,
connectors and retainers, to the abutment teeth. For example,
to evaluate the significance of a simple full crown on a
mandibular molar tooth in a patient with relatively normal
occlusion, a full complement of teeth and normal bone support.
We see that the following parameter of form and forces are
within the control and responsibility of the operator:
a) Number and area of occlusal contacts.
b) Inclination and length of cusps.
c) Axial contours.
require crowns, there is a strong argument for the selection of a
fixed partial denture rather than a removable partial denture[1].
Diagnostic Casts
Accurate diagnostic cast must be correctly oriented to the
transverse hinge axis and the plane of occlusion on an
articulator to permit eccentric movements similar to those that
take place in the mouth. This procedure allows a simple
evaluation of the occlusal relationships of the dental arches and
the abutment teeth.
Roentgenographic Examination
Periapical and bite-wing films are most important in selection
of abutment teeth. The primary purpose of roentgenograms is
to disclose hidden areas and structures such as the root
morphology, pulp outline, the periodontal ligament space, the
alveolar bone, infrabony defects, residual roots, impacted or
supernumerary teeth, and the extent of present or past caries.
Definite rules of treatment planning cannot be formulated.
However, an understanding of the favourable indications and
reasonable limitations of abutments for fixed partial dentures
is essential[2].

Abutment teeth are called upon to withstand the forces
normally directed to the missing teeth, in addition to those
usually applied to the abutments.
If a tooth adjacent to an edentulous space needs a crown
because of damage to the tooth, the restoration usually can
Quick Response Code Address For Correspondence:
Dr. Sumeet Sharma,
Senior Lecturer,
Department of Prosthodontics,
Institute of Dental Sciences,
Sehora, Jammu, India.
Phone no. 09419148335.
E-mail: drsumit02@gmail.com
Factors Governing Abutment Selection
Crown
Gottlieb has suggested a special terminology, anatomic crown
and clinical crown. He calls the enamel covered portion of the
tooth the anatomic crown, and the cementum covered portion,
the anatomic root. Clinically, that portion of the tooth which is
actually erupted (exposed) is called the clinical crown, and the
remainder of the tooth, which is still united with the investing
tissues, the clinical root. Thus, it may be said that in youth the
clinical crown is smaller than the anatomic crown, and in old
age the clinical crown is greater than the anatomic. In certain
mouths, all of anatomic crowns are exposed at the age of 40; in
others, at least for some teeth, there is an epithelial attachment

©Journal of Dental Herald (April 2014, Issue:2, Vol.:1). 038

to the enamel at 50 years or even later.
Size of crown: The combined existing surface area of the
periodontal ligaments of the abutment teeth should be equal or
exceed the normal area of the periodontal ligament of the teeth
to be replaced.[3] The surface area of the periodontal ligaments
of normal teeth has been measured by several investigators.[4],[5]
The total mesio-distal width of the cusps of abutments should
equal or exceed the width of the cusps of pontics.
Occlusal anatomy: Occlusal anatomy has an indirect
influence on the loads transmitted to the teeth. The occlusal
surfaces of natural posterior teeth have distinct cusps with
many primary and supplemental ridges. The cusps are convex
in both directions with grooves interspersed between the
rigdes. Stallard[6] points out that worn-down teeth need more
muscular power and longer and more masticatory strokes in
order to chew food enough. Much of this force is directed at
right angles to the long axis of the teeth.
these patients the prevalence of root surface caries did not
correlate with the degree of oral hygiene or with evidence of
previous coronal caries. "These data suggest that the incidence
of root surface caries may be a function of diet rather than an
inevitable sequelae of root exposure. The root surface
concavities and increased surface area associated with
exposed roots also complicate oral hygiene efforts, thus
favoring an increased incidence of caries. Sensitivity from
exposed root surfaces is also a common problem. A variety of
techniques and substances are available for desensitization."
Unfortunately, no one approach is uniformly successful.
The early guidelines on crown-to-root ratio for abutment teeth
were conservative, but they still serve as a standard in many
texts.[11] Ante's Law[11] states that "The combined pericemental
area of the abutment teeth should be equal to or greater in
pericemental area than the teeth to be replaced." Removal of all
teeth or roots that are "unfit" for further service was also
recommended.

Buccolingual dimension of the teeth: The occlusal surface of
the pontics should harmonize with the buccolingual dimension
of the natural unmutilated teeth, and recreate the normal buccal
and lingual form to the height of contour. Reducing the width
of the pontics does not materially reduces the force transmitted
to the abutments, but merely places heavier per unit stress on
the restoration and produces conditions in the pontic.
Definition and measurement technique:
The level of supporting bone is rarely coincident with the
cementoenamel junction or dentogingival junction(Fig. 1).
Evaluation is best performed using the clinical crown-to-root
ratio. Further use of the term crown-to-root ratio will refer to

Roots
The forces acting on a tooth are transferred to the supporting
bone through the root. The shape of the root determines the
ability of the abutment to transfer the masticatory load to the
supporting bone.
a) Number: Multirooted posterior teeth with widely
separated roots will offer better periodontal support than
roots that converge, fuse, and generally present a conical
configuration.
b) Size: Teeth with longer root are stronger abutment than
compared to the shorter ones.
c) Width: Roots with greater labio-lingual width are
preferred.
d) Shape: Roots with irregular curvature are preferred. Teeth
with conical roots can be used for short span fixed partial
dentures.
Crown: root ratio: Poor crown-to-root ratio can result from
improper dental treatment as well as from traumatic or
pathologic changes that either increase the length of the
clinical crown or decrease the length of the clinical root. In
1955, Marshall-Day and associates[7] found crestal loss of
alveolar bone in 98% or more of a sample of individuals 35 Figure 1
years of age or older. In 1962, examination of a random sample
of Americans revealed the increased prevalence of the clinical ratio unless otherwise specified.
periodontitis and advanced tissue destruction associated with Jepsen[5] compared root surface areas and radio-graphic root
older age groups.[8] areas and established that they could be correlated within a
Mobility, as related to crown-to-root ratio, occurs when 10% to 15% margin of error, thereby demonstrating the
alveolar support is no longer adequate to withstand the forces validity of radiographic evaluation. Workers usually
encountered in the oral cavity. Tooth mobility becomes recommend the use of Ante's Law when allowances for a 15%
significant when the re-quirements of comfort and masticatory to 20% variation in computations of the pericemental area are
function are compromised.[9] Development of dental caries on made." Other textbooks proposed the use of actual crown-to-
exposed root surfaces is a potential problem. A recent study root ratio in determining prognosis. Presumably these are
revealed increased amount of caries on exposed root surfaces based on linear measurements from radiographs. A ratio of 1:2
in the mandibular arch, most frequently in premolars.[10] In was considered ideal. 1:1.5 was acceptable, and a crown-to-

©Journal of Dental Herald (April 2014, Issue:2, Vol.:1). 039

root ratio of 1:1 was considered minimal or doubtful.[12],[13]
Crown-to-root ratio was also discussed in terms of the linear
amount of bone loss although the importance of this approach
varies with root form and length. Teeth exhibiting extensive
bone loss, with pocket depth greater than 6 to 7 mm from the
cementoenamel junction, are sometimes considered hopeless
because of the compromises encountered in periodontal
surgery[13]. Tylman[14] recommended that teeth with a normal
amount of bone be used for abutments. However, he stated that
teeth lacking one third to one half of their normal periodontal
attachment. Beube[15]," discussing the retention or extraction of
teeth, assigned a poor prognosis to teeth with only one third of
the apical bone remaining, advanced mobility, and poor root
morphology. Goldman and Cohen[16]* advocated the retention
of teeth based on their ability to return to health and maintain
themselves in function.
Treatment considerations for teeth with poor crown-root
ratio
Plaque: Plaque control and adequate oral hygiene are of
primary concern in teeth having poor crown-to-root ratio.
Continued progression of periodontitis due to inadequate
plaque control invites treatment failure. Examples are the
addition of margins and solder joints and the exposure of less
accessible, concave crown and root surfaces.
Periodontal surgery: Periodontal surgery can affect the
crown-to-root ratio. Complete: osseous resection of
periodontal bony defects to create physiologic contours may
result in loss of surrounding bone. Selipsky[17]" noted that the
decreased mobility obtained in initial therapy was not
compromised in the long-term (1 year) by definitive surgery
within "clinically operable limits.”
Periodontal support regeneration: Regeneration of lost
periodontal support is the most logical approach to improve
poor crown-to-root ratio, and bone grafting is the most reliable
method. Ingber[18] presented the rationale and technique of
forced eruption as a method of treating one- and two-wall
infrabony defects.
Occlusal reduction: Reducing clinical crown length by
occlusal reduction of extruded teeth is a valid approach to
improving the crown-to-root ratio. Bohannan and Abrams
discussed crown shortening in conjunction with intentional
pulp extirpation. They noted an improved crown-to-root ratio
but encountered complications. For each millimeter of
posterior tooth reduction and resultant decrease in the vertical
dimension of occlusion, an increase of 3 mm of anterior
vertical overlap (overbite) will occur. Overdentures represent
an extreme approach to crown shortening and crown-to-root
ratio improvement, providing a new treatment alternative.
Increasing stability: The mobility seen in teeth with poor
crown-to-root ratio can be reduced by selectively grinding
occlusal surfaces and minimizing horizontal forces in the
existing dentition.[9] Teeth which have poor crown-to-root ratio
and exhibit mobility can be retained through splinting.
Dawson[19] emphasized the difficulty in maintaining good oral
hygiene in splinted areas and suggested splinting only when it
is needed.
Restorative consideration: Cast restorations for teeth with poor
crown-to-root ratios place greater demands on the dentist.
Ideal margins of restorations are essential, since inflammation
has been associated with restorations having excellent
margins.[19]
©Journal of Dental Herald (April 2014, Issue:2, Vol.:1).
Design of the preparations for cast restorations are dictated by
the anatomy of the root surfaces, which may necessitate
endodontic therapy.
Contours must be consistent with existing root contours and
clinical crown form to permit essential hygiene.
Extraction: Extraction must be considered as a treatment
alternative. Removal or retention of molar teeth related to
furcation involvement was reviewed by Saxe and Carmen.[17]
These considerations also applied to teeth with poor crown-to-
root ratio.
These authors suggested that the indications for removal of
problem teeth are
(1) An unopposed terminal tooth in an arch.
(2) A periodontally involved tooth with sound adjacent teeth
providing other treatment alternatives.
(3) A solitary distal abutment that exhibits mobility.
Periodontal factor
Inflammation: A diagnosis of periodontitis is not uncommon
for the patient requiring prosthodontics because one or more
teeth may already have been lost to periodontal disease.
The goals of periodontal therapy for the prosthodontic patient
are: to resolve the inflammation; convert periodontal pocket
depths to clinically normal sulcular depths; establish
physiologic gingival architecture; and provide an adequate
zone of attached gingiva. Adequate oral hygiene is
fundamental to the maintenance of a healthy periodontium.
If surgical intervention is required to achieve therapeutic
goals, approximately six to eight weeks of healing is
recommended before the gingival termination of the tooth
preparations is completed.
Furcation invasions: Teeth with furcation invasions require
special consideration.
Margin placement: G.V. Black's original concepts of
"extension for prevention"[20] have been modified. Broad
extension of cavity preparations to place margins in "caries
immune" areas is not universally advocated. The
recommendation that all gingival finish lines be developed
within the gingival crevice has been challenged.[20],[21]
The gingivae are healthiest when margins are placed well
above (i.e., 1 to 2 mm) the gingival crest[22], and intracrevicular
margin placement is not the universal solution to dental caries.
Biologic width: Histologic studies by Gargiulo, et al[23] have
demonstrated a band of soft tissue attach-ment between the
base of the gingival sulcus and the alveolar crest that is
composed of approximately 1 mm of junctional epithelium
(attachment epithelium) and 1 mm of connective tissue fibers.
This dento-gingival attachment, referred to as the "biologic
width"[24] (Fig.2), has significant implications in treatment
planning. The presence of caries, fractured root structure, or
previous restorations apical to the gingival crest may-
predispose to violation of the biologic width during tooth
preparation. A short clinical crown may induce the dentist to
overextend the preparation apically in an attempt to enhance
retention.[25]
Location in the arch
Parfitt GJ (1960), have shown that the faciolingual movement
ranges between 56-108 µm, and intrusion of 28 µm. Teeth in
different segments of the arch move in different directions.
Because of the curvature of the arch, the faciolingual
040
 Figure 2
movement of an anterior tooth occurs at a considerable angle to
the faciolingual movement of the molar(Fig.3).
ARCH CURVATURE: There is a common problem in
replacing all four maxillary incisors with a fixed partial
denture and the problem is more pronounced in the arch that is
pointed in the anterior. This occurs because the pontics lie
outside the interabutment axis line and thus acts as a lever arm,
which can produce a torquing movement. In order to offset the
torque, additional retention is obtained in the opposite
direction of the lever arm and at a distance from the
interabutment axis equal to the length of the lever arm.
The first premolars sometimes are used as secondary
abutments for a maxillary four-pontic canine to canine fixed
partial denture. Because of the tensile forces that will be
applied to the premolar retainers, they must have excellent
retention(Fig.3).
Figure 3
Angulation
A common problem that occurs with some frequency is the
mandibular second molar abutment that has tilted mesially into
the space formerly occupied by the first molar. It is impossible
to prepare the abutment teeth for a fixed partial denture along
the long axes of the respective teeth and achieve a common
path of insertion. There is further complication if the third
molar is present. It will usually have drifted and tilted with the
second molar. Uprighting is best accomplished by the use of a
fixed appliance.[27] Both premolars and canine are banded and
tied to a passive stabilizing wire.A helical uprighting spring is
inserted into a tube on the banded molar and activated by
hooking it over the wire on the anterior segment.[27],[28] The
average treatment required is 3 months.[29] A proximal half
crown sometimes can be used as a retainer on the distal
abutment.(Fig.4)[33] This preparation design is simply a three-
©Journal of Dental Herald (April 2014, Issue:2, Vol.:1).
Figure 4
quarter down that has been rotated 90 degrees so that the distal
surface is uncovered. A telescope crown and coping can also be
used al a retainer on the distal abutment.[34] A full crown
preparation with heavy reduction is made to follow the long
axis of the tilted molar. An inner coping it made to fit the tooth
preparation, and the proximal half crown that will serve as the
retainer for the fixed partial denture it fitted over the coping.
Conclusion
Competent treatment depends upon the careful examination of
all available information, a definitive diagnosis, and a realistic
treatment plan that offers a favourable prognosis. A
comprehensive, sequential approach to treatment planning is
essential. Planning for fixed prosthodontics must not be
independent of other disciplines of dentistry. Hasty, segmented
planning that ignores major aspects of needed treatments
defies modern concepts of treating “the whole patient” rather
than individual teeth.
When planning and treating cases involving fixed
prosthodontic restorations, it is important that all the
applicable parameters are taken into account. The
prosthodontist must not focus too much on the finer details of
constructing a “perfect” restoration, or risk creating a failure
because proper engineering principles was not used. If success
is to be attained the prosthodontist must take into account the
length of span, attachment apparatus, periodontal bone loss,
inclination of teeth, position in the arch, opposing occlusion to
examine and comes to a specific treatment planning and one
must make use of modern diagnostic tools. One such
indispersible tool at the hand of the operator is the radiograph.
A thorough analysis of the radiograph often reveals that the
abutment teeth may not satisfy the requirement of Ante’s law.
However, long term studies have proved that treatment
regimen & maintainence can convert questionable abutments
into ideal abutments.
Radiographs are made, and pulpal health is assessed by
evaluating the response to thermal and electrical stimulation.
Existing restorations, cavity liners, and residual caries are
removed, and a careful check is made for possible pulpal
exposure. Teeth in which pulpal health is doubtful should be
endodontically treated before the initiation of fixed
prosthodontics. Although a direct pulp cap may be an
acceptable risk for a simple amalgam or composite resin,
conventional endodontic treatment is normally preferred for
041
cast restorations, especially when the later need for endodontic
treatment would jeopardize the overall success of treatment.
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