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

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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Wyatt

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.

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