Failures in FPD

FAILURES IN FPD
1
Guided by- Dr. Mallika Shetty
Presented by- Dr. Snigdha Saha
CONTENTS
 Introduction 6. Fault in laboratory techniques
 Objectives of Fixed Prosthodontic 7. Defects in cementation
Treatment 8. Improper maintaninence
 Classification system of failures of FPD  Review of literature
 Failures due to  Conclusion
1. Improper diagnosis  Summary
2. Improper treatment planning
3. Defect/deficiency in tooth preparations
4. Defect during impression making 2
5. Temporisation
INTRODUCTION
 Fixed prosthodontic treatment can offer exceptional satisfaction for both
the patient and dentist.
 Fixed prosthodontic failures can be frustrating and complex in terms of
both diagnosis and treatment and may occur at any time. Hence, it is
important to be aware of obvious and subtle indications of prosthesis
failure and have a working knowledge of the procedure that are necessary. 3
CHANDRAKALA V, DEEPMALA S, SRIVATSA G. DIFFERENT CLASSIFICATION SYSTEM FOR FAILURES IN TOOTH SUPPORTED FIXED
PARTIAL DENTURE: A SYSTEMATIC REVIEW. INT J PREV CLIN DENT RES 2019;6:17-20.
OBJECTIVES OF FIXED PROSTHODONTIC TREATMENT
 Preservation and improvement of related resistance and stability
hard‐ and soft‐tissue structures  Providing restoration with mechanical
 Preservation or improvement of oral or structural integrity

function  Preserving or improving patient comfort
 Improvement or restoration of esthetics 

Designing restorations for maximum
 Ensuring restoration retention, longevity. 4
MANAPPALLIL JJ. CLASSIFICATION SYSTEM FOR CONVENTIONAL CROWN AND

FIXED PARTIAL DENTURE FAILURES. J PROSTHET DENT 2008;99:293‐8.
“A failure is failure regardless of the reasons attributed to the cause.”
Failures view may be variable which depend on the operator and patients
view.
 Dentists view variability
 Patient view variability
KHIARI A, HADYAOUI D, SAÂFI J, HARZALLAH H, CHERIF M. CLINICAL

ATTITUDE FOR FAILED FIXED RESTORATIONS: AN OVERVIEW. DENT OPEN J. 5
2015; 2(4): 100-104.

Classification system for failures in
tooth‐supported fixed partial denture
6
The first person to classify the failures in fixed partial denture was Tinker in
1920
Chief among the causes for such disappointing results were:

o First: Faulty, and in some cases, no attempt at diagnosis and
prognosis.
o Second: Failure to remove foci of infection in attention to treatment
and care of the investing tissues and mouth sanitation.
o Third: Disregard for tooth form
TINKER ET. FIXED BRIDGE‐WORK. J NATL DENT ASSOC 1920;7:579‐95. 7
o Fourth: Absence of proper embrasures
o Fifth: Inter-proximal spaces
o Sixth: Faulty occlusion and articulation
TINKER ET. FIXED BRIDGE‐WORK. J NATL DENT ASSOC 1920;7:579‐95. 8

Barreto Classification – 1984
1. Biologic – caries, fractures, and generalized periodontal disturbances
2. Esthetics – shapes, contours, and surface characteristics
3. Biophysical – physical properties and chemical composition of porcelain
and metal
4. Biomechanical – faulty designs, misplaced finish lines, rough or sharp
surfaces, and undercuts on the bonding surface cause porcelain to be
dislodged.
9
BARRETO MT. FAILURES IN CERAMOMETAL FIXED RESTORATIONS. J PROSTHET DENT
1984;51:186‐9.
Johnston Classification (1987)
I. Biologic failures
• 1) Caries • 5) Tooth perforation
• 2) Pulp degeneration • 6) Subpontic inflammation
• 3) Periodontal breakdown • 7) General pathosis
• 4) Occlusal problems • 8) Maintenance failure
10
B. Mechanical failures C. Esthetic failures
1) Loss of retention 1) Immediate
2) Connector failure 2) Delayed
3) Occlusal wear
4) Tooth fracture D. Psychogenic
5) Porcelain fracture
1) Lack of counseling
6) Cementation failure
7) Designfailure 11
TEXT BOOK OF PROSTHODONTIC. V. RANGARAJAN TV PADMANABHAN,1ST

EDITITON, ELSEVIER 2013.
John Joy Manappallil (2008)
Class I : Cause of failure is correctable without replacing restoration.
Class II : Cause of failure is correctable without replacing restoration;
however, supporting tooth structure or foundation requires repair or
reconstruction.
Class III: Failure requiring restoration replacement only.
Supporting tooth structure and/or foundation acceptable.
12
Class IV: Failure requiring restoration replacement in addition to repair or
reconstruction of supporting tooth structure and/or foundation.
Class V : Severe failure with loss of supporting tooth or inability to
reconstruct using original tooth support.
Class VI: Severe failure with loss of supporting tooth or inability to
reconstruct using original tooth support.
13
FAILURES DUE TO IMPROPER
DIAGNOSIS
14
15
~Failures due to improper diagnosis
By definition,
Diagnosis: The determination of the nature of a disease.
Treatment plan: The sequence of procedures planned for the treatment of

a patient after diagnosis
GLOSSARY OF PROSTHODONTIC TERMS, EDITION NINE, J PROSTHET DENT; VOLUME 117 ISSUE 5 ;MAY 2017 ; E1-E115 16
Improper case selection:
A. Lack of communication during first visit to determine patients needs
o The chief complaint of the patient which is the reason of patient’s

visit to the dental office has to be given prime importance.
o Unable to fulfil the need of the patient can cause psychogenic or
esthetic failure. Therefore chief complaint of the patient and
determining the need of the patient should be given utmost priority
17
CONTEMPORARY FIXED PROSTHODONTIC 4TH EDITION, ROSENTEIL, ELSEVIER

PUBLICATION,2017
B. Lack of proper medical history to rule out general pathosis
o A patient's medical history is a vital part of his or her dental history

and increases the dentist's awareness of diseases and medication which
might interfere with the patient's dental treatment.
18
Heart disease : Allergies :

 Infection
Dental  Reaction
treatment success might be affected by thetopatient
local systemic
anaesthetics,
health
 Bleeding
hence to avoid the failures caused due toantibiotics, analgesics,
medical conditions latex medical
proper
 Drug
history interaction
is recorded and precaution must be taken .
 Cause an MI or angina
19
C. Patients with High caries index
Two type of carious lesion jeopardized the longevity of the restoration.
First, the carious lesion may develop at the

margins between the tooth & the restoration.
Second, new carious lesion may develop on the

part of root surface distance to the margin of the
restoration. 20
OGINNI AO. FAILURES RELATED TO CROWNS AND FIXED PARTIAL DENTURES FABRICATED IN A NIGERIAN DENTAL SCHOOL. J CONTEMP
DENT PRACT 2005 NOVEMBER;(6)4:136- 143.
Carious lesion at the margin of the restoration may occurs as result of many
factors like
• Marginal distortion
• Surface roughness
• Dissolution of the luting cement
• Loose retainer
• Poor pontic design
• Poor oral hygiene 21
N. HOCHMAN ET AL. A CLINICAL AND RADIOGRAPHIC EVALUATION OF FIXED PARTIAL DENTURES (FPDS) PREPARED BY DENTAL
SCHOOL STUDENTS:A RETROSPECTIVE STUDY. JOURNAL OF ORAL REHABILITATION 2003 30; 165–170
D. Patients with unrealistic demands:
• Unmet expectations can lead to patient dissatisfaction and increase the rate
of failures of the fixed partial denture treatment.
• Appropriate selection of patients is a key to avoiding claims or complaints
arising from patient’s dissatisfaction with the result of a procedure or
treatment due to unrealistic expectations.
22
E. Long span Fixed Partial Denture:
Longevity in fixed prosthodontics is not only dependent 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 such as Ante’s Law.
23
Ante’s law states that “the total periodontal membrane area of the
abutment teeth must equal or exceed that of the teeth to be
replaced
24
The optimum crown root ratio for the tooth which can be utilized as an FPD
abutment is 2:3.
Ideal crown root ratio should be 1:2 which is the Root Surface area should be
double that of the crown surface area But the ratio can be 1:1 which is the Root
can be equal in area to that of the Crown present.
Tooth support varies depending on length and shape of root and not just the
surface area. Long irregularly shaped and divergent roots offer great support.
25
BALEVI B. ANTE'S LAW IS NOT EVIDENCE BASED. THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION. 2012 SEP 1;143(9):1011-2.
Roots with greater faciolingual dimension will make it a superior abutment to

the roots which are circular in cross section.
Short, conical and blunted roots offer poor support, for example, a molar with
divergent roots will provide better support than molar with conical roots with
little or no inter-radicular bone.
Single rooted with elliptical cross section will offer better support than the
tooth with a circular cross section.
26
BALEVI B. ANTE'S LAW IS NOT EVIDENCE BASED. THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION. 2012 SEP 1;143(9):1011-2.
Ben Balevi states that Ante’s law is not evidence based as in his survey
with systemic review he states that the well-maintained, healthy
periodontal tissue support, FDPs not satisfying Ante’s law have survival
rates comparable with the high rates of FDPs that do satisfy Ante’s law.
BALEVI B. ANTE'S LAW IS NOT EVIDENCE BASED. THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION. 2012 SEP 27
1;143(9):1011-2.
F. Periodontally compromised abutments
o Poorly executed restorations provide good support for plaque accumulation,

so gingivitis occurs or worsens.
o The final evaluation of restorative treatment should be judged not only by
aesthetic and functional criteria, but also anticipating the effect that
restoration will have on periodontal structures.
MATEI NM ET AL, PERIODONTAL CONSIDERATIONS IN FIXED PROSTHESES, ROMANIAN 28

JOURNAL OF ORAL REHABILITATION VOL. 6, NO. 1, JANUARY - MARCH 2014.
o Normally, teeth with active periodontal problem should not be used as

abutment teeth.
o The use of multiple splinted abutment teeth, non-rigid connectors or
intermediate abutments makes the procedure much more difficult and
often the result compromises the long-term prognosis.
REYNOLDS J. M. ABUTMENT SELECTION FOR FIXED PROSTHODONTICS. 29

J.PROSTHET.DENT 1968; 19: 483
Periodontal treatment is undertaken to ensure the

establishment of stable gingival margins before
tooth preparation.
Non-inflammed, healthy tissues are less likely to
change as a result of subgingival restorative
treatment or post-restorations periodontal care.
REYNOLDS J. M. ABUTMENT SELECTION FOR FIXED PROSTHODONTICS. 30

J.PROSTHET.DENT 1968; 19: 483
• Sequence of treatment: In general, preparation of the periodontium for

the restorative dentistry can be divided into two phases:
o Control of periodontal inflammation with non-surgical and surgical
approaches
o Pre-prosthetic periodontal surgery
31
SHENOY, ET AL.: PERIODONTAL CONSIDERATIONS DETERMINING THE DESIGN AND LOCATION OF MARGINS IN
RESTORATIVE DENTISTRY, JOURNAL OF INTERDISCIPLINARY DENTISTRY / JAN- APR 2012 / VOL-2 / ISSUE-1
Situations in which a tooth has a short clinical crown and is inadequate for
the retention of a required cast restoration, it is necessary to increase the size
of the clinical crown using periodontal surgical procedures.
Surgical crown lengthening procedures are performed to provide retention

form to allow for proper tooth preparation, impression procedures and
placement of restorative margins and to adjust gingival levels for esthetics.
32
F. Patients with large amount of bone loss
o Intraoral radiographs should be used to

evaluate the bone architecture.
o The alveolar bone support is one of the
most important factors that aid to
evaluate an abutment
33
 Elimination of mobility is not the goal in such cases, but rather the
stabilization of the teeth in a status quo to prevent an increase of
mobility.
 Abutment teeth in these situations can be maintained free of

inflammation in the face of mobility, if the patients are well
motivated and highly proficient in plaque control
34
G. Bilateral edentulous condition

• Bilateral edentulous spaces (Kennedy’s Class 1),which require
cross arch stabilization are one of the contraindication for fixed
partial denture cases.
35
Implant-supported prosthesis can be planned, but it is sometimes not

feasible due to insufficient amount of bone and economic reason.
So, in such situation an acrylic partial denture or a cast partial denture
is largely preferred.
NAVEEN GUPTA, ABHILASHA BHASIN, PARUL GUPTA, AND PANKAJ MALHOTRA, ―COMBINED PROSTHESIS WITH 36
EXTRACORONAL CASTABLE PRECISION ATTACHMENTS,‖ CASE REPORTS IN DENTISTRY, VOL. 2013, ARTICLE ID 282617, 4
PAGES, 2013.
H. Patient with undiagnosed habit of bruxism
Parafunctional behaviours, especially bruxism, are not uncommon

among patient visiting dentists’ clinics daily and they constitute a
major dental issue for almost all dentists.
37
Tomonaga et al in their study about the correlation between sleep bruxism

and dislodgement of dental restoration found that among the severity of
sleep bruxism was a significant impact on shortening the duration of
dislodgement of dental restorations.
TOMONAGA A, IKEDA M, KATO H, OHATA N. [INFLUENCE OF SLEEP BRUXISM ON DISLODGEMENT OF DENTAL 38

RESTORATIONS]NIHON HOTETSU SHIKA GAKKAI ZASSHI. 2005;49(2):221–230.
FAILURES DUE TO IMPROPER
TREATMENT PLANNING
39
~Improper treatment planning
Treatment planning consists of determining a sequence of treatment

logically designed to restore the patients‘ dentition to good health, with
optimal function and esthetics
40
Improper selection of restorative material
Clinician should understand the limitations of appropriate materials and

procedures & this will help prevent experimental approach to treatment.
The most commonly seen systems in the market today are
 ceramo-metal,
 ceramo-zirconia,
 full contour or layered lithium disilicate
 zirconia restorations 41
The gold standard material for FPDs is ceramo-metal with long-term

survival rates ranging from 94.6% at year 5 to 70.8% at year 20
A recent systematic review by Raigrodski et al. showed that ceramo-

zirconia restorations have a survival rate ranging from 73.9% to 100%
up to 5 years.
1. BACKER, H. D. (2008). LONG-TERM RESULTS OF SHORT-SPAN VERSUS LONG-SPAN FIXED DENTAL PROSTHESES: AN UP TO 20-YEAR
RETROSPECTIVE STUDY. THE INTERNATIONAL JOURNAL OF PROSTHODONTICS, 21 (1), 75-85. 42
2. RAIGRODSKI, A. J. (2012). SURVIVAL AND COMPLICATIONS OF ZIRCONIA- BASED FIXED DENTAL PROSTHESES: A SYSTEMATIC
REVIEW. THE JOURNAL OF PROSTHETIC DENTISTRY , 107 (3), 170-177
The most common technical complication with zirconia FPDs is
chipping of the veneering ceramic.
Recent studies show that this may be due to a difference in coefficient of
thermal expansion (CTE) between the layering ceramic and the zirconia
core or the too rapid cooling of the restoration when removing it from
the porcelain furnace.
43
Makarouna et al. found survival probabilities of 63% for 6 years with 3

out of 15 FPDs presenting with framework fracture in the connector area.
MAKAROUNA, M. (2011). SIX-YEAR CLINICAL PERFORMANCE OF LITHIUM DISILICATE FIXED PARTIAL DENTURES . THE 44
INTERNATIONAL JOURNAL OF PROSTHODONTICS, 24, 204- 206.
Considering the information, selection for the correct material would be

based in part on the following factors:
• Location of missing tooth: Occlusal forces are higher in the posterior
area, especially in the second molar area.
• Interocclusal space: All ceramic materials require larger connector size
to avoid catastrophic failures therefore they necessitate larger
interocclusal space.
45
• Parafunctional habits: Patients presenting with obvious signs of bruxism

and/or clenching should not receive all ceramic restorations.
• Aesthetic demands: All ceramic materials offer more aesthetic restorations.
• Allergies: Patients who present with certain allergies to metal might
benefit from all ceramic materials.
46
Improper selection of abutment
The choice and number of abutments are determined by a

combination of load- bearing ability of the abutment teeth plus the
forced and stresses to which these will be subjected.
47
Mesially tilted molars:
Tilted teeth are the

angulated teeth which are
out of ideal centric contact
and deviated from the
normal long axis.
48
Arch form :
o The greatest leverage occurs when the four maxillary incisors are replaced
in a narrow tapered arch.
o A long lever arm can be equalized by using additional abutments.
o The first premolars sometimes are used as secondary abutments for a
maxillary four pontic canine to the canine fixed partial denture
49
HEMMINGS K, HARRINGTON Z. REPLACEMENT OF MISSING TEETH WITH FIXED PROSTHESES. DENT UPDATE 2004;31:137-41.
Span Length:
Bending or deflection varies directly with the

cube of the length and inversely with the cube
of the occlusogingival thickness of the pontic.
50
• To minimize flexing caused by long and/or thin spans, pontic designs

with a greater occlusogingival dimension should be selected.
• The prosthesis may also be fabricated of an alloy with higher yield

strength, such as nickel-chromium.
51
Occlusal Anatomy:
Properly formed occlusal morphology gives correct form, function, and

esthetics to the prosthesis.
Occlusal anatomy has an indirect influence on the loads transmitted to the
teeth.
Importance of Occlusal Morphology Properly formed occlusal surface allows for
small centric contacts which disocclude completely during the lateral excursive
movements of the mandible thus minimizing lateral stresses and frictional wear.52
Un-corrected Occlusal discrepancies

( pathologic occlusion)
• Supra-Eruption
• Tilt and drift
• Gingival Pocket formation and bone loss
53
Enameloplasty can effectively reduce occlusal discrepancy in a

moderately extruded tooth.
If the tooth does not lend itself to Enameloplasty, the placement of

an extra coronal cast metallic restoration is indicated.
Intentional Root Canal treatment of tooth with perfectly vital pulp

may be necessary in cases of hyper erupted tooth
54
• Molar intrusion can be achieved successfully with orthodontic TADS

(Temporary Anchorage Devices) re-establishing a functional posterior
• Orthognathic surgical procedures.
• Extraction of the tooth, in case of the alveolar bone support is lost, i.e. in
cases of furcation involvement.
55
Inadequate bridge design
Under-prescribed (cantilevered, intracoronal retainers): Include design that

are unstable or have few abutment teeth e.g. Cantilever bridge
Overprescribed FPD: Dentist may include more abutment than are necessary
and fate usually dictates that it is the unnecessary retainer that fails 56
Esthetic planning in fixed partial denture:
• Esthetic planning in fixed partial denture is mainly concerned in shade

and placement of the margin of the preparation.
• Shade selection has to be done prior the tooth preparation for better
assessment and outcome of the final restoration.
• Finish line placement is related to the smile line of the patient in anterior
region.
57
MANISHSENKINRA,SHADESELECTIONINFIXEDPARTIALDENTURE,REVISTAKASMERA·
SEPTEMBER 2015
DUE TO DEFECTS/DEFICIENCIES IN
DIFFERENT TECHNIQUES
58
~ Defects in tooth preparation
Tooth preparation is the mechanical alteration of a defective, injured, or

diseased tooth such that placement of restorative material re-establishes
normal form and function, including aesthetic corrections, where
indicated.
GLOSSARY OF PROSTHODONTIC TERMS, EDITION NINE, J PROSTHET DENT; 59

VOLUME 117 ISSUE 5 ;MAY 2017 ; E1-E115 .
60
Damage to adjacent tooth:
 Iatrogenic damage to adjacent tooth enamel during restorative

procedures is a most common and important clinical issue.
 Qvist et al., reported that damaged permanent teeth required
restorations four times as often as undamaged teeth within 5 years.
QVIST V, JOHANNESSEN L, BRUUN M. PROGRESSION OF APPROXIMAL CARIES IN RELATION TO IATROGENIC PREPARATION 61

DAMAGE. JOURNAL OF DENTAL RESEARCH. 1992 JUL;71(7):1370-3.
Iatrogenic damage to the enamel

surface of adjacent tooth is most
often in the form of vertical grooves
up to 1 mm wide, and also appears
as fine scratches, indentations and
extensive damage
62
GOODACRE,CAMPAGNI,ANDAQUILINO;TOOTHPREPARATIONSFORCOMPLETECROWNS: AN ART FORM BASED ON SCIENTIFIC

PRINCIPLES; J PROSTHET DENT 2001;85:363-76.
The accidental damage of proximal

teeth has been linked with increased
caries susceptibility, periodontal
disease and temperature sensitivity.
63
Even if a damaged proximal contact area is carefully reshaped and polished, it
will be more susceptible to dental caries than the original undamaged tooth
surface.
This is presumably because the original surface enamel contains higher
fluoride concentrations and the interrupted layer is more prone to plaque
retention.
The technique of tooth preparation must avoid and prevent damage to the
adjacent tooth surfaces 64
LUSSI A, GYGAX M. IATROGENIC DAMAGE TO ADJACENT TEETH DURING CLASSICAL APPROXIMAL BOX PREPARATION. J DENT
1998;26:435-41.
Teeth are 1.5 to 2 mm wider at the contact area than at the cemento-
enamel junction (CEJ), and a thin, tapered diamond can be passed
through the interproximal contact area to leave a slight lip or fin of
enamel without causing excessive tooth reduction or undesirable
angulation of the rotary instrument.
65
Soft Tissue Injury:
The soft tissues in the mouth which include the tongue, cheeks, gums
and lips are delicate and sensitive and easily prone to damage.
Damage to the soft tissues like the tongue and the cheek occurs during
tooth preparation.
SANJAY MADHAVAN AND DR. SHERLIN HERALD. IATROGENIC SOFT TISSUE INJURIES IN
66
PATIENTS UNDERGOING VARIOUS DENTAL PROCEDURES -A SURVEY AMONG THE DENTAL
PRACTIONNER. INTERNATIONAL JOURNAL OF CURRENT RESEARCH VOL. 8, ISSUE, 09,
PP.38815-38819, SEPTEMBER, 2016.
The 4 most significant factors leading to the soft tissue injuries are :
• Visibility and access: Improper access and visibility may lead to accidental
injuries.
• The presence of local anaesthesia: When the patient’s mouth has been numbed
by the administration of local anaesthesia, they are oblivious to many of these
injuries. This can exacerbate the problem because the dentist is not alerted to
the damage that is being caused until it is too late.
SANJAY MADHAVAN AND DR. SHERLIN HERALD. IATROGENIC SOFT TISSUE INJURIES IN PATIENTS UNDERGOING VARIOUS 67
DENTAL PROCEDURES -A SURVEY AMONG THE DENTAL PRACTIONNER. INTERNATIONAL JOURNAL OF CURRENT RESEARCH
VOL. 8, ISSUE, 09, PP.38815-38819, SEPTEMBER, 2016.
• The use of gloves: A gloved operator may be unaware that instruments

maybe hot enough to cause a burn injury to the unprotected patient’s
tissues.
• Nervous patients: Any procedures which carry the risk of accidental
injuries should be undertaken in the anticipation and readiness so that
patients may not move suddenly and without warning.
68
Pulpal injury:
Despite the emphasis on conservative

preparation methods and restorative
procedures , undeniable threats to
pulpal integrity exist during the
construction of fixed prosthetic
restorations.
CHRISTENSENGJ.AVOIDINGPULPALDEATHDURINGFIXEDPROSTHODONTICPROCEDURES. J AM DENT ASSOC 2002;133:1563-4 69
Anticipated exposures of abutment teeth pulp during tooth preparation is

included in a patient’s treatment strategy regardless of whether or not teeth
present with pulpal pathology.
Unanticipated exposure may create delays in treatment and necessitate
reassessment of the treatment plan by the dentist and the patient.
70
Tooth preparations must take into consideration the morphology of the

dental pulp chamber. Pulp size, which can be evaluated on a radiograph,
decreases with age.
71
Pulp tissue is affected by -

• Temperature
• Chemical agents
• Microorganisms
ROHIT SHETTY ET AL RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-CERAMIC RESTORATIONS WORLD JOURNAL 72
OF DENTISTRY, OCTOBER-DECEMBER 2010;1(3):181- 185.
Temperature
• Heat generated due to friction between rotary instrument and

surface being prepared.
• Excessive pressure, high speed and type, shape and condition of
cutting alters the heat produced.
ROHIT SHETTY ET AL RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-CERAMIC RESTORATIONS WORLD JOURNAL OF 73
DENTISTRY, OCTOBER-DECEMBER 2010;1(3):181- 185.
Chemical action
• Cements, bases and luting agents are known pulpal irritants

• Use of cavity varnish and dentin bonding agents form an
effective barrier in most cases, but their effect on the retention
of cemented crowns is controversial
ROHIT SHETTY ET AL RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-

CERAMIC RESTORATIONS WORLD JOURNAL OF DENTISTRY, OCTOBER- 74
DECEMBER 2010;1(3):181- 185.

Bacteria
Due to bacteria left behind after preparation or having gained access to

dentin due to microleakage.
Thus, removal of all carious dentin is essential before tooth

preparation.
ROHIT SHETTY ET AL RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-

CERAMIC RESTORATIONS WORLD JOURNAL OF DENTISTRY, OCTOBER- 75
DECEMBER 2010;1(3):181- 185.

Inadequate Tooth Reduction
- An improperly prepared tooth may have an adverse effect on long-

term dental health.
- For example, insufficient axial reduction inevitably results in an

over contoured restoration that hampers plaque control. This may
cause periodontal disease or dental caries.
ROHIT SHETTY ET AL ; RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-CERAMIC RESTORATIONS WORLD 76
OURNAL OF DENTISTRY, OCTOBER-DECEMBER 2010;1(3):181- 185.
Inadequate Preparation of Axial Walls:
Inadequate axial tooth preparation forces

technician to make overcontoured crowns and
compromises both esthetics and self-cleansing
design of the restoration.
77
ROHIT SHETTY ET AL ; RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-CERAMIC RESTORATIONS WORLD OURNAL OF
DENTISTRY, OCTOBER-DECEMBER 2010;1(3):181- 185.
Excess Taper of the Prepared Tooth:
Prior to the advent of resin cements, the dentist had to largely depend
on a good retentive form to retain the crown in place.
With resin cements, the scenario has changed.
However, the taper of the prepared tooth should not exceed 8 or 10 degrees
from the long axis of the tooth.
78
Over reduction of Tooth Structure :
• The lack of retention and reduction in the inherent strength of the

remaining tooth structure are apparent disadvantages.
• The damage caused to the dental pulp is indefensible.
ROHIT SHETTY ET AL ; RECTIFYING THE TOOTH PREPARATION ERRORS IN ALL-CERAMIC RESTORATIONS WORLD OURNAL 79
OF DENTISTRY, OCTOBER-DECEMBER 2010;1(3):181- 185.
Inadequate Occlusal Reduction:
Inadequate occlusal reduction will provide insufficient space for the bulk
of ceramic leading to weak areas prone to fracture.
Lack of Uniform Anatomic Reduction :
Uniform multiplane reduction should be patiently done to get the best

strength outcome from the material.
80
Improper tooth preparation causes loss of retention of the prosthesis or

debonding and fracture of the porcelain on the metal substructure.
14 different studies on FPD failures due to loss of retention, concluded that
7% of the FPD failures were as a result of debonding of the retainers.
Loss of retention to be the second most frequently encountered

complication following carious breakdown in ceramo-metal restorations.
81
Finish lines:
Ideally, all finish lines should be placed supragingivally. Due to esthetic

and carious considerations, however, subgingival placement of the
finish line is preferred.
82
Valderhaug J et al in his study firmly established that subgingival crown

margins were associated with gingival bleeding and recession in a
significant number of patients.
Both supra and sub gingival margins influence the periodontal health in a
similar manner with respect to plaque accumulation and gingival health status.
However there was a mild increase in pocket depth with respect to sub gingival
margins. This difference may not be clinically significant
83
PBDS B, VARMA A, JAIN AR. EFFECT OF SUB-GINGIVAL MARGINS INFLUENCING PERIODONTAL HEALTH–A SYSTEMATIC REVIEW
AND META ANALYSIS. BIOMEDICAL AND PHARMACOLOGY JOURNAL. 2017 JUN 20;10(2):739-47.
The knowledge of the responses of periodontal tissues to fixed

partial dentures is crucial in the development of treatment plan with
predictable prognosis.
The most important factor controlling the effects of restorations on
gingival health is the localization of the crown margin relative to
the gingival margin.
DR. WASEEM UL AYOUB, THE EFFECT OF FIXED PARTIAL DENTURES ON PERIODONTAL STATUS OF ABUTMENT 84
TEETH,INTERNATIONAL JOURNAL OF APPLIED DENTAL SCIENCES, 2017; 3(4): 103-106.
~Improper gingival retraction
In order to record subgingivally placed margins, the adjacent soft tissue

needs to be retracted and displaced adequately for the impression
material to penetrate and capture, not only the features of preparation and
finish line, but also some unprepared tooth structure apically.
85
ARVIND MOLDI, SURVEY OF IMPRESSION MATERIALS AND TECHNIQUES IN FIXED PARTIAL DENTURES AMONG THE
PRACTITIONERS IN INDIA; DENTISTRY VOLUME 2013, ARTICLE ID 430214, 5 PAGES.
~Improper gingival retraction
Non use of gingival retraction material causes impression with

merged gingiva to the finish line margin leading to misfit of fixed
partial denture
The injury from cord packing is often accompanied by swelling,

pain, and discomfort. Occasionally, significant infection or loss of
attachment occurs.
86
DEFECTS DURING IMPRESSION
MAKING
87
~Defects during impression making
The majority of impression defects (over one-third) were related to the

margins of the preparations. As the authors observed "this can only lead to
guesswork on the part of the technician and a restoration which will be
compromised from the outset”
WINSTANLEY R B. CROWN AND BRIDGE IMPRESSIONS – A COMPARISON BETWEEN THE UK AND A NUMBER OF OTHER COUNTRIES.
88
EUR. J. PROSTHODONT. REST. DENT. 1999; VOL. 7, NO. 2/3: 61-64.
Tray Adhesive
• The inside of all trays whether perforated or not, should always be coated
with Tray Adhesive in order to help prevent “pull-away‟ and distortion
when removing the tray.
• Use of a tray adhesive also helps to direct polymerisation and thermal
shrinkage toward the tray walls, instead of towards the centre.
89
Separation of the impression

material from the tray may not
be obvious until the restoration
is returned and tried in.
90
Dimensional stability:
 The accuracy of an impression material is dependent on the

dimensional stability.
 The major factors affecting the dimensional change of the impression
are
o thermal contraction,
o polymerization shrinkage
o contraction due to the loss of volatile by products. 91
MC CABE JF AND STORER R : ELASTOMERIC IMPRESSION MATERIALS. BR DENT J, 149:73-79, 1980.

Polyvinyl siloxanes show the smallest dimensional changes on setting of all

the elastomeric impression materials. This is because they are not susceptible
to changes in humidity, and they do not undergo any further chemical reactions
or release any by-products.
TECHKOUHIE A. HAMALIAN IMPRESSION MATERIALS IN FIXED PROSTHODONTICS: INFLUENCE OF CHOICE ON CLINICAL 92

PROCEDURE JOURNAL OF PROSTHODONTICS 20 (2011) 153–160 C 2011 BY THE AMERICAN COLLEGE OF PROSTHODONTISTS
The quality of the impression is affected if there is incomplete mixing of the

base and catalyst
Non reacted material not setting in impression create uneven margins on the
impression records and form a non appropriate model for fixed partial denture
93
causing failure.
Inadequate Margin Detail
Marginal detail is the most critical aspect of

the impression.
Failure to capture the true details of the
margin of the preparation will result in open
margins and inadequate prosthetic fit.
94
Kurtzman G. Common Impression Problems: Identification and Correction. Dental Follicle-The E-Journal of Dentistry. 2015 Oct 1;8(4).
Internal Bubbles
• Internal bubbles occur as a result of either

 Fluid accumulation (when larger and less sharp in definition) or
 Air entrapment (when small and well defined).
• Bubbles on the margins of the preparations can negatively affect the fit
of the prosthetics
Kurtzman G. Common Impression Problems: Identification 95

and Correction. Dental Follicle-The E-Journal of Dentistry.
2015 Oct 1;8(4).
These errors may be avoided by thorough flushing and drying of the

preparation prior to impression taking.
Placing a curved intraoral impression tip into the deepest part of the
preparation floor and extruding a light body polyvinylsiloxane (PVS)
material — making sure to keep the tip in the material as it is expressed —
will force air out of the preparation, decreasing entrapment. 96
Marginal Tears
Marginal tears usually occur when a syringeable material with

insufficient tear strength is used.
Tear strength will vary between manufacturer and viscosities.
Removal of the impression prior to complete setting of the syringeable

material may also cause marginal tearing.
97
Prior to retaking the impression, any remnants of the original impression

material must be removed from the sulcus.
98
Drags and Pulls
A drag results when long, rounded depressions that resemble the cuspal edges
of the teeth are left in the impression material upon insertion of the tray.
Whereas, a pull (also referred to as a fold) results when the material creates a
fold in the material, usually at the gingival aspect.
Kurtzman G. Common
Impression Problems:
Identification and Correction.
99
Dental Follicle-The E-Journal
of Dentistry. 2015 Oct 1;8(4).
Drags and pulls can be avoided by using a less viscous material either syringed
around the teeth or placed over the more viscous material in the tray prior to
insertion.
Correction of a pull in the impression can be accomplished by removal of the

interproximal impression material so the impression can be reinserted
without interference. A syringeable impression material (light or extralight)
should be placed over the entire impression, and the depressions should be
filled. The impression can then be reinserted intraorally. 100
Inadequate Syringe Material:
A “stepped” impression may result when using a two-

phase impression technique and insufficient
syringeable material has been placed.
The result is restorations that require excessive occlusal
adjustments.
101
Inadequate Impression Material Mixing
Once the impression material is combined, it should contain a uniform

colour with no streaking.
Streaking is more common with hand mixed putty materials than with
cartridge materials.
102
DEFECTS IN TEMPORISATION
103
~Defects in temporisation
Fabrication of this definitive prosthesis, on an average takes about 7-10 days

during which the prepared tooth need to be protected from the oral
environment and also its relationship with the adjacent and opposing tooth
need to be maintained.
104
Failures in temporization can badly affect the treatment outcome. These

failures often cause:
1. Sensitivity – before, during and after cementation.

2. Poorly fitting final restorations
3. Hyper occlusion
4. Infecting the dentinal tubules
5. Functional and esthetic failure
105
Marginal Inaccuracy :
Provisional restorations should exhibit accurate marginal adaptation to the

finish line of the prepared tooth in order to protect the pulp from thermal,
bacterial, and chemical insults.
Intrasulcular extension of the preparation requires additional support for

the free gingival margin to provide the appropriate emergence profile.
106
Kaiser DA. Accurate acrylic resin temporary restorations. J Prosthet Dent 1978;39:158–61.
FAILURES IN LABORATORY
TECHNIQUES
107
~Defects in laboratory techniques
Pontic
Tylman states that the designs of pontic can be visualized by analyzing

each pontic surface individually on the mounted diagnostic casts.
• Gingival Surface
• Occlusal surface
• Interproximal surface
• Buccal and lingual surface
108
Connectors:
Failure of solder due to: contamination,

incomplete flow of solder, oxidation, improper
soldering technique, insufficient bulk, porosity
inside the metal.
Thin metal at the connector

109
Retainers
Failure due to:

• Perforation
• Marginal discrepancy
• Facing failure
o Fracture
o Wearing
o Discolouration 110
DEFECTS IN CEMENTATION
111
~Defects in cementation
The most important aims of the luting cements in fixed prosthodontics are
o To prevent the bacteria and oral fluids from penetration into the
prepared surface
o Insulate the thermal conduction
o Retention of the restoration by filling the gap between the tooth
surface and the restoration.
MESU FP, DEGRADATION OF LUTING CEMENTS MEASURED IN VITRO, J. DENT. 112

RES, 61(5), 665-72, MAY 1982.
Clinical evaluation of
prosthesis
-Check for contacts
-Remove the temporary crown.
-Check for the marginal fit
-Clean the prepared tooth with a
-Check for shade matching
scaler, especially, the grooves or slots
-Contours
to overcome incomplete seating of
-Check for occlusion
the crown.
-Do not force a all-ceramic/ PFM
crown/ FPD as it can fracture 113
YÜKSEL E, ZAIMOG ̆ LU A ,,INFLUENCE OF MARGINAL FIT AND CEMENT TYPES ON MICROLEAKAGE OF ALL-CERAMIC CROWN
SYSTEMS, BRAZ ORAL RES. 2011 MAY- JUN;25(3):261-6.
Cementation failure mostly occur as debonding due to following

reasons:
• Cement selection • Inadequate isolation

• Old cement • Incomplete removal of temporary
• Prolonged mixing time cement
• Thin mix • Insufficient pressure
• Cement setting prior to seating
114
DUE TO IMPROPER MAINTENANCE
115
~Due to improper maintenance
Large majority of patients who are satisfied with

all aesthetic and functional aspects of their fixed
prosthesis still in later period of time have faced
failure in fixed partial denture treatment due to
lack of knowledge regarding oral hygiene
measures and the significance of maintenance of
fixed prosthesis using dental aids
116
~Due to improper maintenance
A study by Geiballa states that a high significantly number of patients

did not use any form of interdental aids' to clean their fixed prosthesis
(94%).
The main reason for not using any dental aids' (91.1%) was a lack of
post fixed prosthodontics instructions and not been informed by the
dentist leading to prosthesis failure.
GHADA HASSAN GEIBALLA ET AL PATIENTS' SATISFACTION AND MAINTENANCE OF FIXED PARTIAL DENTURE EUR J 117
DENT, 2016 APR-JUN; 10(2): 250–253
REVIEW OF LITERATURE
118
A systematic review of the survival and complication rates of
fixed partial dentures (FPDs) after an observation period of at
least 5 years
 Aim- The present study was done to determine the long-term success and
survival of fixed partial dentures (FPDs) and to evaluate the risks for
failures due to specific biological and technical complications.
TAN K, PJETURSSON BE, LANG NP, CHAN ES. A SYSTEMATIC REVIEW OF THE SURVIVAL AND COMPLICATION RATES OF FIXED
119
PARTIAL DENTURES (FPDS) AFTER AN OBSERVATION PERIOD OF AT LEAST 5 YEARS: III. CONVENTIONAL FPDS. CLINICAL ORAL
IMPLANTS RESEARCH. 2004 DEC;15(6):654-66.
Conclusion
The 10-year survival rate of FPDs was 89.1%

The 10-year success rate of FPDs was 71.1%
Biological complication:
The 10-year risk for caries on abutments was 9.5%, but only 2.6% of FPDs were
lost as a result of caries.
The pooled 10-year risk for loss of abutment vitality in the present review was
10%
120
The 10-year risk of loss of FPDs due to recurrent periodontitis was only 0.5%.
Technical complications
• The highest 10-year risk was for loss of retention amounting to 6.4%.
• Far lower was the 10-year risk for the loss of FPD due to abutment
tooth fracture, which was 2.1%
• Material complications amounted to a 10-year risk of 3.2%
121
An 18-year retrospective analysis of treatment outcomes with
metal-ceramic fixed partial dentures.
 The aim of this clinical retrospective study was to evaluate the survival and
success rates of metal-ceramic fixed partial dentures (FPDs) made by dental

students over an 18-year interval.
 The survival rate of the FPDs was 78%, and the established success rate was
71%.
122
NÄPÄNKANGAS R, RAUSTIA A. AN 18-YEAR RETROSPECTIVE ANALYSIS OF TREATMENT OUTCOMES WITH METAL-CERAMIC FIXED
PARTIAL DENTURES. INTERNATIONAL JOURNAL OF PROSTHODONTICS. 2011 JUL 1;24(4).
Key indicators of success or survival for clinical perfor
mance of fixed partial denture
123
SEONG LG, MAY LW. KEY INDICATORS OF SUCCESS OR SURVIVAL FOR CLINICAL PERFORMANCE OF FIXED PARTIAL DENTURE.
ANNALS OF DENTISTRY UNIVERSITY OF MALAYA. 2019 DEC 3;26:53-8.
Clinical performance and patient satisfaction obtained with
tooth-supported ceramic crowns and fixed partial dentures
 The purpose of this clinical study was to assess the failure and
complication incidence of tooth-supported ceramic crowns and FPDs in

function for at least 5 years
FORRER FA, SCHNIDER N, BRÄGGER U, YILMAZ B, HICKLIN SP. CLINICAL PERFORMANCE AND PATIENT SATISFACTION OBTAINED
WITH TOOTH-SUPPORTED CERAMIC CROWNS AND FIXED PARTIAL DENTURES. THE JOURNAL OF PROSTHETIC DENTISTRY. 2020 124
OCT 1;124(4):446-53.
• Survival rate for ceramic crowns and FPDs was 97.9% after a mean
observation time of 6.44 ±1.14 years.
• Biological complications were more commonly observed than technical
complications,
• The complication rate was similar for zirconia FPDs and metal-ceramic
FPDs
125
Efficacy and risks of tooth-supported prostheses in the
treatment of partially edentulous patients with stage IV
periodontitis. A systematic review and meta-analysis
 The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed
prostheses in partially edentulous patients with stage IV periodontitis.
 Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore
masticatory function in patients with stage IV periodontitis once periodontal therapy

has been accomplished.
126
SUMMARY
127
Thank You!
128

Failures in FPD

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FAILURES IN FPD

 Fixed prosthodontic treatment can offer exceptional satisfaction for both

the patient and dentist.

 Fixed prosthodontic failures can be frustrating and complex in terms of

 Preservation and improvement of related resistance and stability

hard‐ and soft‐tissue structures  Providing restoration with mechanical

 Preservation or improvement of oral or structural integrity

 Improvement or restoration of esthetics 

MANAPPALLIL JJ. CLASSIFICATION SYSTEM FOR CONVENTIONAL CROWN AND

 Dentists view variability

 Patient view variability

KHIARI A, HADYAOUI D, SAÂFI J, HARZALLAH H, CHERIF M. CLINICAL

2015; 2(4): 100-104.

Chief among the causes for such disappointing results were:

TINKER ET. FIXED BRIDGE‐WORK. J NATL DENT ASSOC 1920;7:579‐95. 8

• 2) Pulp degeneration • 6) Subpontic inflammation

• 3) Periodontal breakdown • 7) General pathosis

• 4) Occlusal problems • 8) Maintenance failure

TEXT BOOK OF PROSTHODONTIC. V. RANGARAJAN TV PADMANABHAN,1ST

Diagnosis: The determination of the nature of a disease.

Treatment plan: The sequence of procedures planned for the treatment of

Improper case selection:

A. Lack of communication during first visit to determine patients needs

o The chief complaint of the patient which is the reason of patient’s

CONTEMPORARY FIXED PROSTHODONTIC 4TH EDITION, ROSENTEIL, ELSEVIER

B. Lack of proper medical history to rule out general pathosis

o A patient's medical history is a vital part of his or her dental history

Heart disease : Allergies :

Two type of carious lesion jeopardized the longevity of the restoration.

First, the carious lesion may develop at the

Second, new carious lesion may develop on the

D. Patients with unrealistic demands:

E. Long span Fixed Partial Denture:

Longevity in fixed prosthodontics is not only dependent upon the

Roots with greater faciolingual dimension will make it a superior abutment to

F. Periodontally compromised abutments

o Poorly executed restorations provide good support for plaque accumulation,

MATEI NM ET AL, PERIODONTAL CONSIDERATIONS IN FIXED PROSTHESES, ROMANIAN 28

o Normally, teeth with active periodontal problem should not be used as

REYNOLDS J. M. ABUTMENT SELECTION FOR FIXED PROSTHODONTICS. 29

Periodontal treatment is undertaken to ensure the

REYNOLDS J. M. ABUTMENT SELECTION FOR FIXED PROSTHODONTICS. 30

• Sequence of treatment: In general, preparation of the periodontium for

Surgical crown lengthening procedures are performed to provide retention

o Intraoral radiographs should be used to

 Abutment teeth in these situations can be maintained free of

G. Bilateral edentulous condition

Implant-supported prosthesis can be planned, but it is sometimes not

H. Patient with undiagnosed habit of bruxism

Parafunctional behaviours, especially bruxism, are not uncommon

Tomonaga et al in their study about the correlation between sleep bruxism

TOMONAGA A, IKEDA M, KATO H, OHATA N. [INFLUENCE OF SLEEP BRUXISM ON DISLODGEMENT OF DENTAL 38

Treatment planning consists of determining a sequence of treatment

Improper selection of restorative material

Clinician should understand the limitations of appropriate materials and

The gold standard material for FPDs is ceramo-metal with long-term

A recent systematic review by Raigrodski et al. showed that ceramo-

Makarouna et al. found survival probabilities of 63% for 6 years with 3

Considering the information, selection for the correct material would be

• Parafunctional habits: Patients presenting with obvious signs of bruxism

The choice and number of abutments are determined by a

Mesially tilted molars:

Tilted teeth are the