Failure Causes of fixed prosthesis failure: 1) Improper case selection 2) Faulty diagnosis & treatment plan 3) Faulty clinical or laboratory procedures 4) Improper care & maintenance Classification of fixed prosthesis failures: |- Biological Failure I- Mechanical failure Uk Esthetic Failure IV- Maintenance failures ’ F- Biological Failure iscomfort, Sensitivity or Pain: due to a) Excessive pressure on soft tissue: * Improper pontic design (no passive contact) ‘* Foreign body pres: 18 on the ridge (excess cement) * Over-extended margin * Improper proximal contact or improper axial contour >> food impaction b) Retention of food on occlusal surface of the prosthesis: * Due to faulty occlusal anatomy >» Solution: is proper occlusal anatomy should be done to create auxiliary escape groove ¢)Traumaticocclusion: —. * Due to premature contact in centric or eccentric movements Y Solution: is selective grinding —_—_“raiire oo © Mit CamScanner gescannt9) Torque on abutment: * Improper sold eB * Improper path of insertion * Absence of provisional >> slight movement of teeth after Impression making Solution: if small >> equilibrated by bone resorption & bone formation OR Remake 'N-B: Torque related to pier abutment can be overcome by ‘non-rigid connector on the distal surface of pier abutment 21 Cervical hyper-sensitivity * Gingival recession (improper tissue retraction) © Short, open margin * Cervical caries + Overextended temporary restoration © Overextended final restoration 2-Caries (It represents 365 of biological failure) Signs &symptoms: Bad taste & breath @ Loose retainers @ Pain Bad esthetics (ifin esthetic zone) Solution: Hfsmall lesion & away from margins >> no need to follow black's Principles >> restored with cement large proximal lesion >> black’s principles are followed >> restored with amalgam or Composite + remake the prosthesis % Ifextensive lesion >> RCT + remake the prosthesis —_—_—— Sire — ® SsSsSsSSsaSaSamanma9mRRnaaSaamTFilen ——_ Mit CamScanner gescannta Caries at Margins: * Due to open, short margins orillfitted restoration ~ Can be detected by sharp explorer or bite wing xray {iinterproximally) b) Caries beneath restoration: * Due to incomplete caries removal * Due to loose retainers >> micro-leakage ~ More common under fixed partial denture than single crown £2 Caries in Root: * Que to decreased salivary flow (old age patients) ~ Commonly associated with gingival recession or PDL pockets * Mechanical - Excessive reduction >> decrease dentin barrier ~ Minute un-noticed pulp exposure + Traumatic occlusion * Chemical: Use of irritating material acid, Zn/Ph cement) © Bacterial: Caries * Absence of temporary protection ‘Signs & Symptoms: Post cementation sensitivity that does not, decrease by time @ Intense pain 5 Per-apical abnormalities (by xray) Solutior Y RCT + Remake the restoration N.B: RCT may be done without removal of the Prosthesis I then closed using composite or amalgam SS Faibere SoS & Mit CamScanner gescannt4- PDL breakdown Causes: * Insufficient number of abutment in long span bridge | PDLaffected abutment * Insufficient axial reduction >> overcontoured restorations * Poor oral hygiene © Forceful gingival retraction * Too deep finish line (ideally midway in the gingival sulcus) Improper prosthesis design which prevent oral hygiene measures (over or undercontouring, open contact, large connector, rough or over extended margins) Signs & Symptoms: & Redness, swelling & bleeding of the gingival tissues around the prosthesis margin PDL pocket formation @ Bad odor & taste @ Pain on biting POL abscess cclusal problems Causes: * Traumatic occlusion which may be: a) Primary occlusal trauma; ~ Due to premature contact (centric or eccentric} on abutment with sound PDL condition ~ Eliminated by occlusal adjustment without permanent damage b) Secondary occlusal trauma: ~ Due to premature contact on PDL affected abutment ~tead to bone resorption >> mobility ————_—_—_—_ Fife. — {) ~The ——_ Mit CamScanner gescanntSigns & Symptom: & Discomfort & sensitivity on biting @ Muscle pain & strain TMI problems Widening of POL membrane space Bone resorption & mobility N-B: Premature contact can also lead to pulp damage >> RCT §-Tooth Perforation Cause * Faulty preparation of pinholes Faulty drilling or post insertion .ocation of perforation: a) Perforation in the bifurcation area >> Extraction b) Perforation into the pulp chamber >> RCT > tooth Preparation should extend to cover the Perforation 9) Lateral perforation into POL ligaments >> PDL Surgery >> closed with MTA (Mineral Trioxide Aggregate) 7: Abutment Fracture Z-Abutment Fracture a} Coronal tooth fracture: causes: + Recurrent caries © Over-reduction * Heavy occlusal forces/Premature contact (especially if RCT teeth) * Improper removal of cemented prosthesis Solution: 1 In partial coverage restoration ~ 1 small fracture around margins >> restored by gold fol or resin cement + Iflarge fracture >> new full coverage restoration 2:n full coverage restoration (horizontal coronal fracture ~ RCT >> post & core >> new restoration r3 Failure —__ ——= i? Mit CamScanner gescanntb) Root fracture: Causes: © Over widening of root canal during post preparation * Type of post used (Resistance form of the post) ie: Metal o zirconia, threaded, parallel. + Caries extending to root surface 8: Allergic reaction (Nickel, Resin or Impression materials} II- Mechanical Failure © Trauma 1: Looseness (Dislodgment] ~ Detected by lifting the retainers up & down {occluso-cervically) with a curved explorer placed under the connector >> bubbles at margins as air & fluids are displaced es: A) Lack of retention: due to: 2) Faulty preparation © Over convergence © Over occlusal reduction ‘© Short post preparation © Improper grooves & pinholes Preparation b) Improper prosthesis design © Use of partial coverage when full Coverage is indicated © Insufficient number of abutments in long span bridges © The use of gold alloys with low ‘modulus of elasticity in long Span bridges ©) Improper prosthesis construction © Iihfitted prosthesis © Un-adapted margins 8) Recurrent caries: © Due to cement dissolution ooo Fite 4) Mit CamScanner gescannt‘Torque: © Premature contact © Parafunctional habits © Different type of occ n. he. one end of the bridge is opposed by natural teeth while the other end is opposed by RPD D) Mobility of abutment teeth ELImproper cementation technique: © Use of improper luting agent © Improper isolation during cementation © Improper manipulation (proportioning, mixing, applicaion,..) © Unsteady positioning of the prosthesis during cement setting 2: Prosthesis Fracture 2: Prosthesis Fracture A) All ceramic fracture: Causes: 1) Faulty preparation: ©. Sharp tooth preparation © Insufficient reduction © Over occlusal reduction © Insufficient finish line thickness © Excessive roundation of line angles 2) Faulty construction: © Improper porcelain construction © Improper firing cycles 3L Eaulty cementation: © Improper cement selection © Excessive force during cementation 4) Improper case selection: © Deep bite, edge to edge, heavy occlusal bite ___ Failure (8) Mit CamScanner gescanntTypes of all ceramic fractures: Vertical MW) Facial cervical fracture (semilunar): ~ Sharp tooth preparation ~Sharp tooth preparation ~ Sharp internal angle of finish ine (shoulder F..) ~ Edge to edge bite ~ Insufficient finish line thickness ~ Over occlusal reduction ~ Short inciso-gingival height lil) Lingual cervical fracture (semilunar): ~ Deep bite + Insufficient lingual reduction ~ Heavy occlusal bite BlVeneering fracture (over metal or zirconia framework : Causes: © Problem in metal >> improper metal framework design © Problem in porcelain >> improper laboratory procedures Or excessive occlusal function © Problem in metal-porcelain bond: ¥ Builuce of compressive bond between porcelain & metal >> due to large mismatch in Coefficient of thermal expansion (coefficient of thermal expansion of metal should be slightly higher than porcelain by 1x10 “Pe Failure of chemical bond between porcel excessive oxides ~ failure of mechanical bond between porcelain & ‘metal >> due to improper sandblasting or contamination of metal surface A.Connector fracture: Causes: © Improper connector size & metal >> due to lack of oxides or © Porosity © Improper soldering technique © Strain due to bending in long span bridges D) Post fracture: Causes: © Weak material (fiber post) © Too thin post © Porosity Mit CamScanner gescanntOcclusal Wear (Perforation} ~ Occlusal perforation >> leakage >> cement dissolution >> failure Causes: © Insufficient occlusal reduct tion © Thin metal thickness © Heavy occlusal forces. (parafunctional habits) Sout Intra-oral repair, Extra-oral repair (free hand soldering) or Remake III- Esthetic Failure Al Related to Reduction: * Insufficient reduction (cervical or incisal) "Reduction of labial surface in one plane 8) Related to Porcelain: * Improper shade selection "Improper alignment * Improper contour * Improper size (proportioning) "Improper shape ©) Related to Cement: "Improper cement shade (especially under laminate veneers) "Thick cement shade D) Related to Metal: * Improper masking of metal color by porcelain facing * Metal display in veneered crown or partial coverage restorations IV- Maintenance failures ~ Itis the most important Point in survival of the prosthesis ~Perioge recall should be done to: monitor patient's dental health, prophylactic plaque control & Identify incipient problems ———————— 3) _ en —— Mit CamScanner gescannt