Japanese Dental Science Review (2014) 50, 2328Review Article

The current status of the design ofresin-bonded fixed partial dentures,splints and overcastings

Hiroshi Shimizu *, Tomohiro Kawaguchi, Yutaka Takahashi

Division of Removable Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College,Fukuoka, Japan

Received 24 May 2013; received in revised form 18 October 2013; accepted 28 October 2013

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242. Design of anterior resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243. Design of posterior resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254. Design of resin-bonded overcastings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265. Future outlook for the design of resin-bonded prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

KEYWORDSDesign;Resin-bonded fixedpartial denture;Resin-bonded splint;Resin-bondedovercasting;D-shaped design

Summary This review article describes the current status of resin-bonded fixed partialdenture, splint and overcasting design. Several such designs have been introduced throughthe years, but there is no typical standard yet for the design of anterior resin-bonded prostheses.On the other hand, the design of posterior resin-bonded prostheses has generally been a standardD-shaped structure. To splint abutment teeth, including pathological mobile teeth, the applica-tion of resin-bonded retainers with additional retentive structures is recommended. Although aconventional design for resin-bonded overcastings has not been established yet, it is usually easyto add mechanical structures. The problem in clinical practice is the esthetics of the retainers,although the key to solving this problem may be to apply tooth-colored material.# 2013 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.

* Corresponding author at: Division of Removable Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, 2-15-1, Tamura,Sawara-ku, Fukuoka 814-0193, Japan. Tel.: +81 92 801 0411; fax: +81 92 801 0513.

E-mail address: simizuh1@college.fdcnet.ac.jp (H. Shimizu).

Available online at www.sciencedirect.com

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1882-7616/$ see front matter # 2013 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.jdsr.2013.10.003

24 H. Shimizu et al.tive functional monomer for adhesives to enamel, dentin,dental alloy and ceramic. The history of the clinical applica-tion of resin-bonded fixed partial dentures (RBFPDs) thusstarted in the true sense of the word. The creation offunctional monomers for noble metal alloys containing sulfur(VBATDT [6,7], MTU-6 [8] and MDDT [9]) represents excellentprogress in resin-bonded prosthetic practice. It should bepointed out that an oxidation surface treatment for metals isno longer required in this new adhesive system. Using func-tional monomers including VBATDT, MTU-6 or MDDT, gold alloyand AgPdCuAu alloy adhere directly to the resin materi-als. The procedure is easy to perform, and technique errorsare less likely to occur in the clinic. Thereafter, a new era inthis field began with the use of noble metal alloys includingAgPdCuAu alloy, and the design of resin-bonded pros-theses has been re-evaluated.

Thus in recent years, regardless of whether the location isposterior or anterior, RBFPDs, as well as oral implants, havebeen accepted as an alternative to conventional fixed partialdentures when intact abutments are present and minimalintervention is desired [10]. It seems that the RBFPD designswith tooth reductions look similar to conservative partialveneer abutment preparations. The present review articlefocuses on the current status and future outlook for thedesign of RBFPDs, as well as for splints and overcastings.

2. Design of anterior resin-bondedprostheses

The application of the splinting system reported by Rochette[1] has been limited to the mandibular anterior regionbecause it was conceived as a temporary procedure withno tooth reduction. Howe et al. [11] tried to use perforatedretainers for the replacement of missing anterior teeth with-out tooth reduction by selecting situations with open bites orminimal occlusal function on the restoration. However, theretainers frequently fractured due to insufficient strength, soa high level of skill at the cementing procedure was needed.The Maryland Bridge was the earliest representative of a non-perforated retainer design; a base metal alloy retainer of theRBFPD covered most of the lingual and proximal areas of theanterior abutments with a small amount of tooth reduction[2] (Fig. 1). Restoration has demonstrated the supragingivalmargins that are a common feature of resin-bonded pros-theses. Even if the abutment tooth is intact, sufficientocclusal clearance must be provided for the retainers ofmaxillary anterior RBFPDs. Furthermore, it is generally

believed nowadays that the tooth preparation design foranterior RBFPDs should include grooves [12] or a pinhole[1316] as additional retentive structures (Figs. 24). Amethodical preparation design for anterior abutmentsintended to preserve the patients innate occlusal guidance[17] (Figs. 5 and 6). This design extends the reduction to partof the occlusal wear facets, making it possible to preserve thepatients innate occlusal function and hold the retainerfirmly. Consequently, the functional force from the antag-onistic teeth should load the retainer and enamel facetsequally. Such force should correctly press the retainers tothe abutments and should not debond the retainer from thebonded enamel. One of the remaining problems of maxillaryanterior RBFPDs is the difficulty involved in thickening the

Figure 2 Definitive cast shows preparations with grooves andpinholes in central and lateral incisors.

Figure 3 Intaglio view of the anterior resin-bonded fixedpartial denture (RBFPD) with retentive pin.1. Introduction

In 1973, Rochette [1] reported on a peculiar splinting systemusing composite resin as a cementing agent to attach perfo-rated cast metal retainers to the acid-etched enamel ofperiodontally compromised lower anterior teeth. This systemwas conceived as a temporary procedure involving no toothreduction. Livaditis et al. [2] and Thompson et al. [3,4]introduced the so-called Maryland Bridge technique usingelectrolytically etched nonprecious Ni-Cr alloys. In thismethod, the tooth preparation consisted of a small amountof reduction including proximal extensions as a definitiveprocedure. In 1978, 4-methacryloxyethyl trimellite acidanhydride (4-META) was synthesized [5] and used as a reac-Figure 1 Occlusal view of the early completed anterior Mary-land Bridge.

Figure 7 Definitive cast shows preparations of the typicalposterior early Maryland Bridge in premolar and molar.

Design of resin-bonded fixed partial dentures, splints and overcastings 25Figure 4 Completed RBFPD after placement.retainers due to anterior-guided occlusion. However, nodesign has ever resolved this problem.

Splinting with partial veneered restorations is consideredto be useful as are full coverage restorations for stabilizingthe dentition with pathological mobility mainly caused byperiodontal diseases. However, a long-term follow-up [18]indicated that mobility of the abutment teeth is one of thedecisive prognostic factors for the success of RBFPDs.Furthermore, it was reported that a RBFPD without anyretentive preparation form failed at a significantly higherrate [19]. Therefore the application of resin-bonded retai-ners with additional retentive structures, such as a pinholeand grooves in the anterior region, a method combiningenamel etching and the use of unfilled resin adhesive, wasrecommended [20].

Figure 6 Completed RBFPD blends well in the patients oralcavity.

Figure 5 Definitive cast shows partial preparation in canine aswell as conventional full coverage preparation in central incisor.3. Design of posterior resin-bondedprostheses

The early design of the posterior Maryland Bridge includedaxial coverage and an occlusal rest, as shown in Figs. 7 and 8.There was little proximal and lingual enamel reduction.Posterior RBFPDs appeared to require a 180-degree-pluscircumferential preparation for predictable success, basedon the results of the first 5 years of a 10-year longitudinalstudy [21]. Then it was realized that the preparation designshould include mechanical retention such as grooves forresistance [2224]. The L-shaped retainer covers onehalfof the lingual cusp with a groove at the far side of the buccalline angle as well as a groove at the opposite far side of thelingual line angle in order to hold the abutment teeth firmly.Recently, a D-shaped retainer has become popular. Chowet al. [25] presented an approach using a groove, plate,and strut, which involved minimal preparation of the poster-ior abutment to receive a RBFPD using a base metal alloy.Botelho et al. [26] advised that the major retainer shouldhave a wrap-around configuration on at least three surfacesof the abutment or have strategically placed opposing axialgrooves or slots for long-span prostheses that replace two ormore missing teeth. Another report [27] described a meth-odical preparation for posterior partial veneered restorationsthat provides sound posterior occlusal function and isolatesthe occlusal contact area in the enamel to maintain thevertical dimension of occlusion. It is especially effectiveFigure 8 Lingual view of the completed posterior early Mary-land Bridge.

Figure 9 Definitive cast shows D-shaped preparation in secondpremolar and enamel island preparation in second molar.

26 H. Shimizu et al.Figure 10 Buccal view of the completed posterior RBFPD.when a prosthesis has not been seated very long to replacethe missing teeth, and the intact mesial and distal teethincline toward the missing space (Figs. 9 and 10).

4. Design of resin-bonded overcastings

The overcasting technique was originally a technique designedto avoid removal of restorations, such as fractured metalceramic fixed partial dentures [2830] or adjacent FPDs[31]. The technique remarkably developed through the useof adhesive resin cement with metal conditioners [32,33]. Anovercasting restoration may provide faster treatment, fewerappointments, less discomfort, simpler laboratory proce-dures, and lower cost compared to replacing the restoration.

Figure 11 Preparations with two retentive pinholes for anovercasting.Figure 12 Intaglio view of the overcasting with two retentivepins.

Figure 13 Completed overcasting blends well in the patientsoral cavity.Fig. 11 shows a preparation with two retentive pinholesfor an overcasting in response to an esthetic request fromthe patient. Although the typical design of resin-bondedovercastings has not yet been established, it is generallyeasy to add mechanical structures such as grooves andpinholes in overcastings compared to intact teeth. In thissituation, the overcasting was cast with type III gold alloywith highly filled composite (Fig. 12). The facial surfaces ofthe metal premolar restorations were replaced with anovercasting with indirect composite using an adhesiveluting agent (Super-Bond C&B Ivory, Sun Medical Co.,Ltd., Moriyama, Japan) which resulted in a good appear-ance (Fig. 13).

5. Future outlook for the design of resin-bonded prostheses

Evaluation of the current status indicates that the design ofposterior resin-bonded prostheses has almost become D-shaped. This design is almost complete with no clinicallysignificant problems and will be used for the foreseeablefuture. On the other hand, there is no typical standard yetfor the design of anterior resin-bonded prostheses. The avail-able surfaces to be bonded are limited from the estheticviewpoint to the lingual surface and a portion of the proximalsurface in the anterior region. Hence, it is difficult to use awrap-around design in this region. Consequently, there isa limitation to adding mechanical retention obtained by designalthough the improvement of the bond strength of the

Design of resin-bonded fixed partial dentures, splints and overcastings 27Figure 14 Anterior RBFPD using zirconium oxide on the defini-tive cast.

Figure 15 Completed anterior RBFPD using zirconium oxideblends well in the patients oral cavity.adhesive resin material is definitely needed, particularly inthis region.

One practical clinical problem is the esthetics, a problemthat will not resolve itself even if a D-shaped design is appliedas long as a metal alloy is used in the retainer. The key to solvingthis problem may be to use tooth-colored material such asZirconium oxide [3436] and fiber-reinforced composite [3741] as the framework of the resin-bonded prosthesis (Figs. 14and 15). There is a basic problem because the toughness ofthese materials is lower than that of dental alloys. It wasreported that in zirconia restorations, the inlay and buccalretainers have a failure load equivalent to that of a full crown[35]. Especially with zirconia, the retainer design also dependson the performance of the CAD/CAM system. On the otherhand, in their review paper, van Heumen et al. stated that itwas not possible to build a reliable regression model indicatingthe risk factors in fiber-reinforced composite-RBFPDs [38].Therefore, the fundamental retainer design of resin-bondedprostheses should be established by using materials that aredifferent from the metal retainer system.

Conflict of interest statement

The authors declare no conflicts of interest. The authors aloneare responsible for the content and writing of the article.

References

[1] Rochette AL. Attachment of a splint to enamel of lower anteriorteeth. J Prosthet Dent 1973;30:41823.[2] Livaditis GJ, Thompson VP. Etched castings: an improved reten-tive mechanism for resin-bonded retainers. J Prosthet Dent1982;47:528.

[3] Thompson VP, Livaditis GJ. Etched casting acid etch compositebonded posterior bridges. Pediatr Dent 1982;4:3843.

[4] Thompson VP, Del Castillo E, Livaditis GJ. Resin-bonded retai-ners. Part I: resin bond to electrolytically etched nonpreciousalloys. J Prosthet Dent 1983;50:7719.

[5] Takeyama M, Kashibuchi S, Nakabayashi N, Masuhara E. Studieson dental self-curing resins. (17). Adhesion of PMMA with bovineenamel or dental alloys. Shika Rikogaku Zasshi 1978;19:17985[in Japanese].

[6] Mori K, Nakamura Y. Study on triazine thiols V Polymerization of6-(4-vinylbenzyl propyl) amino-1,3,5-triazine-2,4-dithiol oncopper plates and their corrosion resistance. J Polym Sci PolymLett Ed 1983;21:88995.

[7] Kojima K, Kadoma Y, Imai Y. Adhesion to precious metalsutilizing triazine dithione derivative monomer. J Jpn Dent Mater1987;6:7027.

[8] Kimura M, Aizawa M. Thiouracil derivative. Japan Patent Appli-cation H10-1473, 1998

[9] Fujii T, Aoki S, Torii K, Teramae M, Negoro N. Metal adhesivecomposition. Japan Patent Application 2003-238326, 2003.

[10] Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal inter-vention dentistrya review. FDI Commission Project 1-97. IntDent J 2000;50:112.

[11] Howe DF, Denehy GE. Anterior fixed partial dentures utilizingthe acid-etch technique and a cast metal framework. J ProsthetDent 1977;37:2831.

[12] Burgess JO, McCartney JG. Anterior retainer design for resin-bonded acid-etched fixed partial dentures. J Prosthet Dent1989;61:4336.

[13] Lankford RJ, Christensen LC. Pin-retained, resin-bonded fixedpartial dentures. J Prosthet Dent 1991;65:46970.

[14] Lacy AM. Improved retention for bonded cast metal rests: a casereport. Quintessence Int 1991;22:43942.

[15] Miara P, Touati B. A pin-assisted retention technique for resin-bonded restorations. Pract Periodontics Aesthet Dent1992;4:217.

[16] Shimizu H, Takahashi Y. Anterior maxillary resin-bondedfixed partial denture to preserve occlusal surface area foranterior guidance. A clinical report. N Y State Dent J 2007;73(4):2830.

[17] Shimizu H, Takahashi Y. Tooth preparation design for anteriorabutments of resin-bonded fixed partial dentures: a technicalreport. Gen Dent 2007;55:4268.

[18] Probster B, Henrich GM. 11-year follow-up study of resin-bond-ed fixed partial dentures. Int J Prosthodont 1997;10:25968.

[19] Behr M, Leibrock A, Stich W, Rammelsberg P, Rosentritt M,Handel G. Adhesive-fixed partial dentures in anterior and pos-terior areas. Results of an on-going prospective study begun in1985. Clin Oral Investig 1998;2:315.

[20] Shimizu H, Habu T, Yanagida H. Stabilization by splinting of anendodontically treated premolar and a minimally reduced vitalcanine with a resin-bonded cast retainer: A clinical report. IntChin J Dent 2002;2:1215.

[21] Crispin BJ. A longitudinal clinical study of bonded fixed partialdentures: the first 5 years. J Prosthet Dent 1991;66:33642.

[22] Simon JF, Gartrell RG, Grogono A. Improved retention of acid-etched fixed partial dentures: a longitudinal study. J ProsthetDent 1992;68:6115.

[23] El Salam Shakal MA, Pfeiffer P, Hilgers RD. Effect of toothpreparation design on bond strengths of resin-bonded prosthe-ses: a pilot study. J Prosthet Dent 1997;77:2439.

[24] Emara RZ, Byrne D, Hussey DL, Claffey N. Effect of grooveplacement on the retention/resistance of resin-bonded retai-ners for maxillary and mandibular second molars. J ProsthetDent 2001;85:4728.

[25] Chow TW, Chung RW, Chu FC, Newsome PR. Tooth preparationsdesigned for posterior resin-bonded fixed partial dentures: aclinical report. J Prosthet Dent 2002;88:5614.

[26] Botelho MG, Dyson JE. Long-span, fixed-movable, resin-bondedfixed partial dentures: a retrospective, preliminary clinicalinvestigation. Int J Prosthodont 2005;18:3716.

[27] Shimizu H, Takahashi Y. Preparation for posterior partialveneered restoration to maintain vertical dimension of occlu-sion. N Y State Dent J 2007;73(5):5860.

[28] Wood M, Litkowski LJ, Thompson VP, Church T. Repair of porce-lain/metal restoration with resin bonded overcasting. J EsthetDent 1992;4:1103.

[29] Matsumura H, Atsuta M. Repair of an eight-unit fixed partialdenture with a resin-bonded overcasting: a clinical report. JProsthet Dent 1996;75:5946.

[30] Mancuso A. Salvaging a porcelain/metal bridge with a bondedporcelain-fused-to-metal overcasting. Gen Dent 2003;51:4567.

[31] Szikman M, Silverstein LH, Kurtzman D. Salvaging of adjacentfixed partial dentures using an overcasting technique. DentToday 1997;80:823.

[32] Shimizu H, Takahashi Y. Fixed splinting device to be usedwithout removing adjacent existing cast restorations. J ProsthetDent 1999;82:2312.

[33] Tanoue N, Ogata T, Koizumi H, Matsumura H. Repair of ananterior fixed partial denture with a resin-bonded overcastingand a dual functional metal priming agent: a clinical report. IntChin J Dent 2006;6:1720.

[34] Rosentritt M, Kolbeck C, Ries S, Gross M, Behr M, Handel G.Zirconia resin-bonded fixed partial dentures in the anteriormaxilla. Quintessence Int 2008;39:3139.

[35] Aboushelib MN, Feilzer AJ, Kleverlaan CJ, Salameh Z. Partial-retainer design considerations for zirconia restorations. Quin-tessence Int 2010;41:418.

[36] Mehl C, Ludwig K, Steiner M, Kern M. Fracture strength ofprefabricated all-ceramic posterior inlay-retained fixed dentalprostheses. Dent Mater 2010;26:6775.

[37] Shinya A, Yokoyama D, Lassila LV, Shinya A, Vallittu PK. Three-dimensional finite element analysis of metal and FRC adhesivefixed dental prostheses. J Adhes Dent 2008;10:36571.

[38] van Heumen CC, Kreulen CM, Creugers NH. Clinical studies offiber-reinforced resin-bonded fixed partial dentures: a system-atic review. Eur J Oral Sci 2009;117:16.

[39] Keulemans F, Van Dalen A, Kleverlaan CJ, Feilzer AJ. Static anddynamic failure load of fiber-reinforced composite and partic-ulate filler composite cantilever resin-bonded fixed dentalprostheses. J Adhes Dent 2010;12:20714.

[40] Yokoyama D, Shinya A, Gomi H, Vallittu PK, Shinya A. Effects ofmechanical properties of adhesive resin cements on stressdistribution in fiber-reinforced composite adhesive fixed partialdentures. Dent Mater J 2012;31:18996.

[41] Antonopoulou A, Papadopoulos T, Hatzikyriakos A. In vitroevaluation of shear bond strength and mode of failure of theinterface between an indirect composite bonded to fiber-rein-forced composite substructures. J Prosthodont 2012;21:4519.

28 H. Shimizu et al.

The current status of the design of resin-bonded fixed partial dentures, splints and overcastingsIntroductionDesign of anterior resin-bonded prosthesesDesign of posterior resin-bonded prosthesesDesign of resin-bonded overcastingsFuture outlook for the design of resin-bonded prosthesesConflict of interest statementReferences