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    JCDA JCDA www.cda-adc.ca/jcda December 2007/January 2008, Vol. 73, No. 10 933

    ClinicalP R A C T I C E

    Contact Author

    Resin-Bonded Fixed Partial Dentures:

    Whats New?

    Chris C.L. Wyatt,DMD, MSc, FRCD(C)

    ABSTRACT

    Background and Objective: Dentists often question the use of resin-bonded fixed

    partial dentures (RBFPDs) for reliable restoration of tooth-bound edentulous spaces.

    Initial attempts at bonding fixed partial dentures on teeth resulted in early failure due

    to debonding. In the 1980s and 1990s, improvements in preparation methods, metal

    alloys and bonding techniques made the RBFPD a more predictable option. In this

    paper, we summarize recent information concerning its success and failure.

    Methods: A MEDLINE search using key words describing RBFPDs was carried out to

    identify pertinent English articles appearing in peer-reviewed journals since 2000.

    Results: The principle reason for failure of RBFPDs remains debonding of the frame-

    work from the abutment teeth. Selection of nonmobile abutment teeth, preparation

    to enhance retention and resistance form, choice of the appropriate alloy and metal,

    and tooth bonding technique are the keys to success. The use of cantilever and nonrigid

    attachments may decrease interabutment forces and reduce debonding of retainers.

    Conclusions: The survival rate of RBFPDs is still considerably lower than that of conven-

    tional fixed partial dentures. Although RBFPDs can be used in both the anterior and

    posterior regions of the mouth to replace 1 or 2 missing teeth, careful abutment selec-

    tion, tooth preparation, alloy selection and bonding technique are critical for clinicalsuccess.

    The prosthetic restoration o small eden-tulous spans poses a dilemma when theadjacent teeth do not require crowns. It

    is difficult to justiy extensive reduction o theadjacent teeth to support a conventional fixedpartial denture. A single-tooth implant is an

    alternative or patients with adequate bonedimensions and who are willing to undergo aminor surgical procedure. However, oral im-plants are not the treatment o choice or manypatients and the resin-bonded fixed partialdenture (RBFPD) offers a possible solution.

    In the 1970s, Howe and Denehy1 adaptedthe Rochette bonded cast-metal periodontalsplint concept2to create the first RBFPD. Teearly procedures were conservative, but prob-lems with debonding resulted in a survivalrate o only 28% at 7.5 years. 3 o enhance

    retention and resistance orm o posteriorRBFPDs, Livaditis4recommended preparationo parallel guide suraces on the interproximaland lingual aspects o the adjacent teeth alongwith rests on the occlusal aspect to counteractdislodging orces. Resin bonding was urther

    Dr. Wyatt

    Email:[email protected]

    For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-73/issue-10/933.html

    mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
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    Wyatt

    enhanced by using solid electrolytically etched base-

    metal-alloy casting.5 Te result was a doubling o the

    survival rate to 64% at 7.5 years.3In the 1980s and 1990s,

    significant advances in metal surace treatment, dentin

    bonding and resin cements potentially improved the clin-

    ical success rate o RBFPDs. A meta-analysis6 identified

    60 papers published in the 1980s reporting success rates

    or various designs; Kaplan-Meier statistical analysis

    determined an overall survival o 74% 2% at 4 years or

    1,598 RBFPDs compared with 74% 2% at 15 years or

    4,118 conventional fixed partial dentures.

    In this paper, we summarize outcomes o RBFPDs

    published in English-language, peer-reviewed journals

    since 2000. In addition, new inormation concerning

    preparation, material selection and bonding o RBFPDs is

    explored. Articles were identified by a MEDLINE search

    using key words describing RBFPDs.

    Patient Selection

    Patients with small edentu-lous spans bounded by sound teethare good candidates or RBFPDs(Fig. 1). Te potential abutmentteeth should be healthy, unrestored

    or minimally restored, ree o cariesand periodontal disease, and have anadequate crown height and width. Anonmobile tooth with an adequatesurace area o enamel provides anideal abutment. Although the youngare more likely to have sound teeth,debond rates are higher amongpeople under 30 years o age.7

    Although the RBFPD is consid-ered a definitive solution or single-unit edentulous spaces bounded by

    healthy teeth, case reports on the useo this procedure as a provisionaltreatment continue to be published.Poyser and others8 recommendthe Rochette bridge as an alterna-tive to an acrylic resin removablepartial denture. Al-Wahadni andAl-Omari9calculated a 90.5% successrate over the short term (35 months)or 21 RBFPDs used as provisionalprostheses immediately ollowingtooth extraction. wo mandibularposterior devices ailed afer 3 and4 months due to trauma, but weresuccessully rebonded.

    Tooth Preparation

    Since 2000, modification o thetooth preparation process has been

    advocated to enhance retention and resistance orm oRBFPDs. Te goal is to create a defined path o inser-tion or the ramework while minimizing the display ometal. Frameworks have been extended maximally onthe lingual aspect o teeth to improve resistance orm andprevent dislodgment o the restoration. Te use o defined

    rest preparations (cingulum and occlusal) has been ad-vocated to provide support or prevent dislodgement to-ward the gingival aspect. Te use o proximal grooves onmolars in preparation or RBFPDs has resulted in signifi-cant improvements in retention and resistance as meas-ured by dislodgement orces on maxillary ivorine teeth;however, no significant improvement has been noted ormandibular molars.10 Although tooth preparation is re-quired, less than hal the amount o coronal tooth struc-ture by weight is removed compared with that removedor complete coverage crowns.11 According to studies odebonding, the mean debonding rate or RBFPDs placed

    Figure 1: (a) Facial view of missing maxillary left lateral incisor. (b)Occlusal view ofmissing maxillary left lateral incisor.

    Figure 2: (a)Tooth preparation finish lines for anterior resin-bonded fixed partial den-ture (RBFPD). (b)Facial view of anterior RBFPD. (c) Palatal view. (d)Occlusal view.

    c d

    a b

    a b

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    Fixed Partial Dentures

    without retentive tooth preparationwas 47% compared with only 11% orthose with retentive preparation.7

    El-Moway and Rubo12 recom-mend an anterior design involving a0.5-mm lingual reduction o enamel

    and a 1-mm supragingival reductionextending to the centre o the inter-proximal contact, with an incisalfinish line 2 mm short o the incisaledge or optimal esthetics (Fig. 2).Adequate and parallel axial reduc-tion o the proximal surace adjacentto the edentulous area and extendinglingual to the planned interproximalcontact is required or a path o in-sertion and retention. Maximum ex-tension onto the proximal suraces

    with proximal grooves will enhanceresistance or the RBFPD and pre-vent mesiodista l and aciolingualdislodgement. A cingulum rest witha flat floor will provide support, pre-venting movement toward the gin-gival aspect.

    A posterior design that createsparallelism between the proximal suraces o the teethadjacent to the edentulous space creates an optimal in-sertion path.12,13 Te supragingival preparation, 0.5 mmwithin enamel, should extend rom the acial line anglelingual to just short o the interproximal contact area on

    each o the adjacent teeth. Occlusal rests and the base othe lingual grooves provide support, preventing move-ment toward the gingival aspect (Fig. 3). Alternatively,slot or box preparations replacing existing restorationsmay be used or ramework support. Creating a box witha slight convergence toward the occlusal aspect to lockin the composite resin cement can enhance retention.12A similar posterior design has been recommended byChow and others14with the addition o a palatal grooveand an occlusal strut (mesial-distal groove) to enhanceresistance orm. Shimizu and akahashi15describe a pos-terior design that involves preparation extending rom a

    mid-buccal to a mid-lingual groove and incorporating anocclusal rest on each abutment tooth. However, this dis-play o metal on the buccal surace may not be acceptablewhere esthetics are a concern.

    Alternative Designs

    Te use o a single abutment to support a single ponticmay be a viable alternative RBFPD design, at least oranterior regions. Te design principles are the same as orthe conventional RBFPD, with conservative tooth prepar-ation, but optimizing resistance orm.16 Te preparationshould be confined to enamel as much as possible and

    maximize the surace area to enhance bonding o a rigid

    ramework. Occlusion on the pontic should be kept to a

    minimum and molar-sized pontics should be avoided.

    A review17 o 11 clinical studies using cantilevered

    RBFPDs concluded that this prosthetic design was re-

    liable and predictable and had greater longevity than

    conventional RBFPDs with 2 abutments. Compared with

    conventional RBFPDs, this restoration is claimed to have

    better esthetics, to involve less tissue damage, to be easier

    to clean, to be less expensive and to have no chance o

    undetected debond due to its single retainer.17 When

    269 2-unit cantilevered RBFPDs were ollowed or at least

    2 years, debonding occurred in 14 (94.8% success rate);

    no changes in occlusion occurred in relation to drifing

    o abutment teeth.18

    Te integration o a nonrigid connector between the

    abutment and the pontics o long-span, RBFPDs with2 or more pontics may reduce debond ailure by allowing

    independent movement o the abutment teeth.19Tis de-

    sign reduces the interabutment stresses that tend to cause

    debonding. Te nonrigid connector is designed to allow

    movement in the vertical and horizontal planes, such that

    the least mobile retainer contains the matrix.19A clinical

    success rate o 92.2% was noted or 43 RBFPDs with 2 or

    more pontics that were ollowed up to 87 months. 20 All

    ailed prostheses replaced posterior teeth, and adverse

    occlusal contacts on the abutment teeth were speculated

    to be the cause o this ailure.

    Figure 3: (a)Tooth preparation finish lines for posterior resin-bonded fixed partial den-ture (RBFPD).(b) Facial view of posterior RBFPD.(c) Palatal view.(d)Occlusal view.

    a b

    c d

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    Bonding

    Te preparation o abutment teeth or RBFPDs

    using the previously described 0.5-mm axial reduction

    with urther reduction or grooves, boxes and rest seatslikely exposes dentin. An in vitro study o 20 extracted

    premolars ater RBFPD preparation noted dentin

    exposure on all specimens; the mean area o exposurewas 11.06 mm2 (16.15%).21 Preparation o 1-mm deep

    interproximal grooves exposed dentin in all teeth. Axialreduction resulted in variable dentin exposure at the

    gingival margin. Reliance on dentin bonding in modern

    RBFPD preparation designs seems a reality.Base metal alloys, typically nickelchromiumberyl-

    lium, are preerred over gold alloys due to their enhanced

    bond to resin cements. In vitro testing using aqueousaging and cyclic loading o Panavia-F (Kuraray Co., Ltd.,

    Osaka, Japan) cemented RBFPDs determined that de-

    bonding was a result o cohesive ailure within the cement

    at the fillerresin interace.22 No difference in debondrates over 6 and 12 months was noted between nickelchromium based RBFPDs cemented with Panavia 21

    Opaque (Kuraray Co., Ltd.) and Scotchbond Multi-Purpose

    with Scotchbond Resin Cement (3M Dental Products,St. Paul, Minn.); however, the latter (a clear cement) was

    associated with graying o the abutment teeth.23

    In vitro testing o combinations o chromecobaltmetal surace treatments and resin cements ound the

    use o Unifix (Cavex Holland BV, Haarlem, Holland) andairborne-particle abrasion (50 micron aluminium oxide)

    provided the firmest physical bond.24 Similar research

    using nickelchromium alloy also resulted in good bondstrengths.25 Airborne-particle abrasion o the alloy sig-

    nificantly improved bond strength; urther enhancement

    was achieved by using 96% isopropanol or 3 minutesin an ultrasonic cleaner-than-air dryer or an additional

    3 minutes.25

    Use o tin-plating gold alloys to enhance bonding hasnot been predictable and led researchers to explore other

    surace treatments. Te use o a metal primer (AlloyPrimer, Kuraray Co., Ltd.) significantly improved the

    tensile bond strength between goldpalladium alloys

    and human enamel compared with airborne-particle

    abrading and tin plating.26

    Tis primer is based onacetone, 10-methacryloyloxydecyl dihydrogen phosphate

    and 6-vinylbenzyl-n-propyl amino triazine dithione. Teuse o a vinyl-thiol primer (a solution o acetone con-

    taining 0.5% 6-[4-vinylbenzyl-n-propyl] amino-1,3,5-triazine-2,4-dithiol) to bond gold alloy based RBFPDs

    resulted in a clinical success rate (76.9% at 10 years) sim-

    ilar to that or conventional base-metal alloys.27Te useo silica coating to enhance bonding o RBFPD rame-

    works resulted in a similar survival rate.28

    El-Moway and Rubo12recommend rubber dam isola-tion to enhance bonding o the RBFPD to tooth structure.

    A retrospective study o 100 RBFPDs placed between

    1993 and 2003 ound that various preparation designs,metal alloys, metal preparations, number o abutments

    and pontics were not predictive o debonding.29However,

    the use o rubber dam during cementation significantlyreduced the risk o debonding.

    Esthetics

    Multiple questionnaires completed by 358 patientsduring regular recalls revealed that the degree o satisac-

    tion with RBFPDs was high and did not seem to be influ-

    enced by the occurrence o ailure. 30However, satisactionwas correlated with complaints about colour and shape

    o the pontics. Te metal ramework o resin-bonded

    bridges may also darken thin or translucent abutmentteeth; 5 studies identified this problem, with an overall

    occurrence o 18%.7 Te racture o porcelain on thepontics is an esthetic complication that was identified in

    15 studies with a mean incidence o 3%.7

    Clinical Success and Failure

    An extensive literature review7 to identiy the inci-

    dence o complications in fixed prosthodontics included

    RBFPDs. Tis study reviewed 56 publications, althoughwhen multiple reports on the same patient groups were

    eliminated, only 8 papers published between 1984 and

    1998 remained. A total o 1,823 complications occurredin 7,029 RBFPDs in service or 1 month to 15 years. Te

    overall debond rate o 21% affected 1,481 prostheses. Te

    debond rate during the first 2 years was 10%, between

    25 years the rate was 20%, and at > 5 years the ratewas 24%. Te debond rate or RBFPDs with more than

    1 pontic (52%) was double that or rameworks supportinga single pontic.

    Individual studies reporting on success o currentdesign principles and bonding techniques show promise.

    Te mean survival rate, based on bond retention, was

    85% afer 5 years or 100 RBFPDs placed between 1993and 2003 at the University o urin.29 Te annual de-

    bond rate over 3 years was 4.6% or 59 RBFPDs placed by

    predoctoral dental students.31 Te debond rate was3 times higher in the mandible than the maxilla, with

    the poorest survival (debond rate 13.4%) in the anteriormandible. No differences in periodontal health (bleedingon probing and pocket depth) were noted between abut-

    ment teeth and controls.

    Using Kaplan-Meier analysis, Zalkind and others32determined that 51 conventional base-metal alloy

    RBFPDs placed under controlled clinical conditions and

    ollowed over 13 years had a mean lie expectancy o85 months (7 years) 13%. Coxs proportional hazard

    analysis revealed that abutment teeth that were periodon-

    tally involved (relative risk [RR] 9.40) and were treatedollowing orthodontics (RR 7.88) were significantly

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    Fixed Partial Dentures

    associated with ailure o RBFPDs. ooth mobility was

    the likely cause o ailure in both these situations.

    Te use o supragingival margins should allow or

    adequate oral hygiene to control dental plaque and pre-

    vent gingivit is, periodontitis and dental car ies. A lack

    o clinical impact on gingival and periodontal condi-

    tions has been reported; however, 22 studies o RBFPDsreporting on caries revealed a mean occurrence o 7%.7

    Te complicating actor may be debonded rameworks;

    7 studies reported on caries in conjunction with de-

    bonded retainers.

    Te use o cantilevered RBFPDs may be a viable

    alternative to 2 abutment RBFPDs. Kaplan-Meier sur-

    vival est imates showed no significant difference be-

    tween the survival rate or 77 RBFPDs (63%) and 25

    cantilevered RBFPDs (81%) afer 4 years.33 A review o

    2-unit cantilevered RBFPDs at the Prince Philip Dental

    Hospital (Hong Kong) revealed that 82 prostheses had a

    survival rate o 95.1% over the short term (mean servicelie 36.7 15.4 months; range 4.395.4 months).34 Tis

    high success rate may be due to minimal unction or oc-

    clusal load.

    Patient Satisfaction

    Mandibular bilateral distal extension cantilevered

    RBFPDs were ound to be equivalent or superior to re-

    movable partial dentures or 60 patients who completed

    satisaction questionnaires.35 No difference in quality

    o lie was noted between patients provided with im-

    plant crowns and those receiving RBFPDs.36 Tis study

    compared 11 patients with implant crowns and 33 with

    RBFPDs; the 2 groups were matched or gender, age,

    edentulous span and location o prostheses within the

    mouth. Te sel-administered quality-o-lie question-

    naire contained 2 subscales related to oral condition

    (mastication, pronunciation, swallowing, oral cleaning

    and esthetics) and general condition (physical unction

    and psychological state). No differences were noted

    between treatment types. Patient satisaction with canti-

    levered RBFPDs was also high; however, 10% were con-

    cerned about the metal appearance o the prostheses.34

    Conclusions

    RBFPDs can be used successully in both the an-

    terior and posterior regions o the mouth to replace 1 or

    2 missing teeth. However, the survival rate o RBFPDs

    is still considerably less than that o conventional fixed

    partial dentures. Te principle reason or ailure is de-

    bonding o the ramework rom the abutment teeth. Te

    use o cantilevered and nonrigid attachments may de-

    crease interabutment orces and reduce debonding o

    retainers. Te selection o nonmobile abutment teeth,

    preparation designs that enhance retention and resist-

    ance orm, appropriate alloy selection and metal andtooth bonding technique are critical or success. a

    THE AUTHOR

    Dr. Wyatt is associate professor and head of the division ofprosthodontics , depar tment of oral health sc iences, faculty ofdentistry, University of British Columbia, Vancouver, BritishColumbia.

    Correspondence: Dr. Chris C.L. Wyatt, Department of Oral HealthSciences, Faculty of Dentistry, University of British Columbia,2199 Wesbrook Mall, Vancouver, BC V6 1Z3.

    Te author has no declared financial interests in any company manufac-turing the types of products mentioned in this article.

    Tis article has been peer reviewed.

    References

    1. Howe DF, Denehy GE. Anterior fixed partial dentures utilizing the acid-etchtechnique and a cast metal framework.J Prosthet Dent1977; 37(1):2831.

    2. Rochette AL. Attachment of a splint to enamel of lower anterior teeth.J Pros thet Dent1973; 30(4):41823.

    3. Creugers NH, Kayser AF, vant Hof MA. A seven-and-a-half-year survivalA seven-and-a-half-year survivalstudy of resin-bonded bridges.J Dent Res1992; 71(11):18225.

    4. Livaditis GJ. Cast metal resin-bonded retainers for posterior teeth.J Am DentAssoc 1980; 101(6):9269.

    5. Livaditis GJ, Thompson VP. Etched castings: an improved retentive mecha-nism for resin-bonded retainers. J Pros thet Dent 1982; 47(1):528.

    6. Creugers NH, Kayser AF, Vant Hof MA. A meta-analysis of durabilityA meta-analysis of durabilitydata on conventional fixed bridges. Community Dent Oral Epidemiol1994;22(6):44852.

    7. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complicationsin fixed prosthodontics.J Prosthet Dent2003; 90(1):3141.

    8. Poyser NJ, Briggs PF, Chana HS. A modern day application of the Rochette

    bridge.Eur J Prosthodont Restor Dent2004; 12(2):5762.9. Al-Wahadni AM, Al-Omari WM. Immediate resin-bonded bridgework:Immediate resin-bonded bridgework:results of a medium-term clinical follow-up study. J Oral Rehabil 2004;31(1):904.

    10. Emara RZ, Byrne D, Hussey DL, Claffey N. Effects of groove placementon the retention/resistance of resin-bonded retainers for maxillary andmandibular second molars.J Pros thet Dent2001; 85(5):4728.

    11. Edelhoff D, Sorensen JA. Tooth struc ture removal associated with variouspreparation designs for anterior teeth.J Prosthet Dent 2002; 87(5):5039.

    12. El-Mowafy O, Rubo MH. Retention of a posterior resin-bonded fixedpartial denture with a modified design: an in-vitro study. Int J Prosthodont2000; 13(5):42531.

    13. El-Mowafy O, Rubo MH. Resin-bonded fixed partial dentures a litera-ture review with presentation of a novel approach. Int J Prosthodontont2000;13(6):4607.

    14. Chow TW, Chung RW, Chu FC, Newsome PR. Tooth preparations de-signed for posterior resin-bonded fixed partial dentures: a clinical report.

    J Pros thet DentProsthet Dent2002; 88(6):5614.

    15. Shimizu H, Takahashi Y. Retainer design for posterior resin-bonded fixedpartial dentures: a technical report. Quintessence Int2004; 35(3):6534.

    16. Botelho M. Design principles for cantilevered resin-bonded fixed partialdentures. Quintessence Int2000; 31(9):6139.

    17. Van Dalen A, Feilzer AJ, Kleverlaan CJ. A literature review of two-unitcantilever FPDs. Int J Prosthodont2004; 17(3):2814.

    18. Botelho MG, Leung KC, Ng H, Chan K. A retrospective clinicalevaluation of two-unit cantilevered resin-bonded fixed partial dentures.

    J Am Dent As soc 2006; 137(6):7838.

    19. Botelho MG. Improved design of long-span resin-bonded fixed partialdentures: three case reports. Quintessence Int 2003; 34(3):16771.

    20. Botelho MG, Dyson JE. Long-span, fixed-movable, resin-bondedLong-span, fixed-movable, resin-bondedfixed partial dentures: a retrospective, preliminary clinical investigation.Int J Prosthodont 2005; 18(5):3716.

  • 7/25/2019 Maryland California

    6/6

    938 JCDA JCDA www.cda-adc.ca/jcda December 2007/January 2008, Vol. 73, No. 10

    Wyatt

    21. Bassi GS, Youngson CC. An in vitro study of dentin exposure duringresin-bonded fixed partial denture preparation. Quintessence Int 2004;35(7):5418.

    22. Walker MP, Spencer P, Eick JD. Effect of simulated resin-bonded fixedpartial denture clinical conditions on resin cement mechanical properties.

    J Oral Rehabil2003; 30(8):83746.

    23. Aboush YE, Estetah N. A prospective clinical study of a multipurposeadhesive used for the cementation of resin-bonded bridges. Oper Dent

    2001; 26(6):5405.24. Van Dalen A, Feilzer AJ, Kleverlaan CJ. The influence of surfacetreatment and luting cement on in vitro behavior of two-unit cantileverresin-bonded bridges. Dent Mater 2005; 21(7):62532.

    25. Quaas AC, Heide S, Freitag S, Kern M. Influence of metal cleaningmethods on the resin bond strength to NiCr alloy. Dent Mater 2005;21(3):192200.

    26. Petrie CS, Eick JD, Williams K, Spencer P. A comparison of 3 alloy surfacetreatments for resin-bonded prostheses. J Pros thodont2001; 10(4):21723.

    27. Hikage S, Hirose Y, Sawada N, Endo K, Ohno H. Clinical longevityof resin-bonded bridges using a vinyl-thiol primer. J Oral Rehabil 2003;30(10):10229.

    28. Ketabi AR, Kaus T, Herdach F, Groten M, Axmann-Krcmar D, ProbsterL, and other. Thirteen-year follow-up study of resin-bonded fixed partialdentures. Quintessence Int2004; 35(5):40710.

    29. Audenino G, Giannella G, Morello GM, Ceccarelli M, Carossa S, Bassi F.Resin-bonded fixed partial dentures: ten-year follow-up. Int J Prosthodont2006; 19(1):223.

    30. Creugers NH, De Kanter RJ. Patients satisfaction in two long-termPatients satisfaction in two long-termclinical studies on resin-bonded bridges.J Oral Rehabil2000; 27(7):6027.

    31. Aslani E, Johansson J, Moberg LE. Resin-bonded bridges by dental under-Resin-bonded bridges by dental under-graduates: three-year follow-up. Swed Dent J2001; 25(1):219.

    32. Zalkind M, Ever-Hadani P, Hochman N. Resin-bonded fixed partial

    denture retention: a retrospective 13-year follow-up. J Oral Rehabil 2003;30(10):9717.

    33. Chai J, Chu FC, Newsome PR, Chow TW. Retrospective survival analysisof 3-unit fixed-fixed and 2-unit cantilevered fixed partial dentures. J OralRehabil2005; 32(10):75965.

    34. Botelho MG, Chan AW, Yiu EY, Tse ET. Longevity of two-unit canti-levered resin-bonded fixed partial dentures.Am J Dent 2002; 15(5):2959.

    35. Jepson N, Allen F, Moynihan P, Kelly P, Thomason M. Patient satisfactionfollowing restoration of shortened mandibular dental arches in a random-ized controlled trial. Int J Prosthodont 2003; 16(4):40914.

    36. Sonoyama W, Kuboki T, Okamoto S, Suzuki H, Arakawa H, Kanyama M,and others. Quality of life assessment in patients with implant-supportedand resin-bonded fixed prostheses for bounded edentulous spaces. Clin OralImplants Res2002; 13(4):35964.