Resin bonded bridges.modi /certified fixed orthodontic courses by Indian dental academy

Resin Bonded Fixed Partial
Denture –case reports.

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

1

Introduction
• The need for conservation of natural tooth
structure has always been the desired but
elusive goal in dentistry.
• In fixed partial prosthodontics this goal
manifests itself with the continued interest
and development of Resin bonded fixed
partial dentures (RBFPD).

2

Definition
• Resin bonded prosthesis
A prosthesis that is luted to tooth
structure,primarily enamel,which has been etched
to provide mechanical retention for the resin
cement. -GPT-7
• Also called as Maryland bridges, Rochette
bridges.

3

Why a Re-Look ?
1. Sometimes Cost and other constraints
make single teeth implants unfeasible.
2. Recent and further scope of Advances in
adhesive dentistry.
3. Lesser failure rates of RBFPD’s found in
recent studies.


4

History and development
• Development of Acid etching of enamel by
Buonocore.
• Bowen developed the BIS-GMA composite
resins.


5

Rochette bridge

• Developed in 1973.
It was a complete innovation.
Use of ring like retainers,with funnel shaped
perforations through them to enhance resin
retention.
Silane coupling agent was used to produce
adhesion to the metal.

6

Maryland ridge
• Etched metal surface
first developed by
Livaditis and
Thompson.
• Treatment of metal
surface with acids
and controlled
electric current.

7

Virginia bridge.
• Roughned surface of the retainer itself
provides for retention
• Achieved by lost salt technique.
• Air abrasion with aluminium oxide.


8

Advantages of Resin bonded
bridges.
1)
2)
3)
4)
5)

Reduced cost .
No anesthetic needed.
Supragingival margins.
Minimal tooth preparation.
Rebonding possible.

9

Indications.
1) Adolescents with single missing teeth (traumatic
or congenital).
2) Caries- free abutment teeth and good oral
hygiene.
3) Maxillary incisor replacements (most favourble
prognosis) and Mandibular incisor replacements.
4) Periodontal splints.
5) Single posterior tooth replacements.

10

• Survival rates of FPD
– 96% at 5 years
– 74% at 15 years
• Creugers et al 1994.

• Survival rates of RBFPD
– 74% at 4 years (meta study)
– 93% at 11 years Barrack


11

Tooth preparation
 The strength of bonding to prepared and
etched enamel is greater than that to etched
but unprepared enamel.(Aker et al 1979)
 Preparation should cover as large as area
as esthetically possible


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Cervical margin
should always be
in enamel and
Supragingival.
Preparation should
ensure precise
insertion and
seating of the
framework.
180 0 wraparound
of the metal.

13

Case-1
• History


14

Examination
• Root exposure of
central incisor and
canine.
• Widened edentulous
space mesiodistally.
• I mm over jet and
overbite


15

• Good oral hygiene and favorable periodontal
status.
• Study models were made and articulated.
• Radiographs were taken.


16

Treatment plan
• Resin bonded fixed partial denture was
the treatment of choice
1. As it kept the option of going for bone

grafting and implant a possibility.
2. Angulation of abutments and gingival
recession made the possibility of 3 unit
conventional FPD a difficult proposition.

17

Tooth preparation
• Very
conservative
palatal
preparation.
• Supragingival
chamfer.
• Proximal groves.

18

Laboratory procedure
• Wax pattern was made
and casted in Ni-Cr
alloy.
• Pontic was made in
appropriate shade of
ceramic.
• Holes were made on the
wings to facilitate light
curing of composite.

19

Bonding steps.
• Sand blasting of
metal framework.
• Acid etching
• Rinsing and drying.
• Contamination to be
avoided at all cost.


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26

Case 2
• Missing
mandibular
Right
central
incisor


27

• Bone loss and
gingival recession
in abutment teeth.
• Grade 1 mobility.


28

Treatment plan.
• Resin bonded fixed partial denture was
the treatment of choice.
As patient wanted a fixed replacement of
the missing teeth.
Need for splinting the lower anteriors.


29

Tooth preparation


30

• Conventional
Maryland
bridge
fabricated
with porcelain
fused to metal
pontic.

31

• Bonded with
resin cement.


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Case 3
• 16 year old
female patient.
• Traumatic loss of
maxillary left
central incisors .
• Using RPD for
3 years.


35

• Ridge
resorption.
• Widened
pontic space.


36

Treatment plan
Resin bonded bridge was the treatment of
choice.
• Taking into consideration age of the
patient.
• Need for the conservative treatment.


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38

Case –4
Metal free resin bonded bridge
• Loss due to trauma.
• Highly reduced
pontic space.


39

Treatment plan.
Metal free resin bonded bridge was the
treatment of choice
• As patient had edge to edge bite - less
unfavourable stresses transmitted to the
prosthesis.
• Superior esthetics.


40

Treatment plan
• Proximal
slicing of the
abutments was
done to
distribute the
space evenly.
• Diagnostic
wax up was
shown to the
patient

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Temporization


43

Laboratory procedures
• Hardcore porcelain fired on refractory cast.(Hi –
ceram)
• Porcealin build up done on the coping .


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Disadvantages
•
•
•
•
•

Irreversible.
Uncertain longevity.
No space correction.
No alignment correction.
Difficult temporization.

49

Contraindications.
•
•
•
•

Extensive caries.
Nickel sensitivity.
Deep vertical overbite.
Extensive restoration on abutment
teeth.
• Parafuncitonal habits

50

Conclusion
• Rapid development in adhesive technology
holds a promising future for RBFPDs, which
were originally developed as an interim
restoration. Today high success rate and
reducing cost is fast making RBFPD’s as a
treatment alternative for permanent oral
rehabilitation.


51

• Furthermore in a
developing country
like
India
this
esthetic
approach, which is
cost
effective
too,
holds
promising future.

52


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Resin bonded bridges.modi /certified fixed orthodontic courses by Indian dental academy

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Resin bonded bridges.modi /certified fixed orthodontic courses by Indian dental academy