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1. DIAGNOSIS AND TREATMENT PLANNING IN
FIXED PARTIAL DENTURES
Introduction
- Fixed prosthodontic treatment can offer exceptional satisfaction
for both patient and the dentist.
- Fixed prosthodontics can transform an unhealthy, unattractive
dentition with poor function into a comfortable, healthy occlusion
capable of giving years of further service while greatly enhancing
esthetics.
- To achieve success, requires meticulous attention to every detail
from initial patient interview through the active treatment phases
to a planned schedule of follow-up care.
- Problems encountered during treatment can often be traced to
errors and omissions during history taking and initial
examination.
- Diagnosis: It is the examination of the physical state, evaluation
of mental or psychological makeup and understanding the needs
of each patient to ensure a predictable result.
1

2. - Treatment planning: It means developing a course of action that
encompasses the ramifications and sequelae of treatment to serve
the patient’s needs.
Chief Complaint:
It should be recorded in patients own words. The accuracy and
significance of patient’s primary reason /reasons should be analyzed
first. This will reveal problems and conditions of which the patient is
often unaware.
History:
A patient’s history should include all necessary information
concerning the reasons for seeking treatment, along with any personal
details and past medical and dental experiences that are pertinent. A
screening questionnaire is useful for history taking.
Medical History:
An accurate and current general medical history should include
any medication the patient is taking as well as all relevant medical
conditions.
a) Any disorders that necessitate the use of antibiotic
premedication, any use of steroids or anticoagulants and any
2

3. previous allergic responses to medication or dental materials
should be recorded.
b) Any conditions affecting the treatment plan e.g.:
various radiation therapy, haemorrahgic disorders etc. should be
recorded.
c) Possible risk factors to the dentist and auxiliary
personnel, e.g. carriers of Hepatitis B, Aids or Syphilis are
recorded so that adequate measures can be followed when
treating known carriers.
Dental History:
Periodontal, restorative and endodontic history are first noted.
Orthodontic history should be an integral part of the assessment of a
prosthodontic dentition. Occlusal adjustment may be needed to promote
long term positional stability of the teeth and reduce or eliminate
parafunctional activity. Restorative treatment can often be simplified by
minor tooth movement. When a patient is contemplating orthodontic
treatment, much time can often be saved if minor tooth movement for
restorative reasons is incorporated from the start.
TMJ dysfunction history
3

4. A history of pain or clicking in the temporomandibular joints or
neuromuscular symptoms, such as tenderness to palpation, may be due
to TMJ dysfunction which should be treated before fixed prosthodontic
treatment begins.
4

5. EXTRAORAL EXAMINATION
Cervical lymph nodes, TMJ and muscles of mastication are
palpated.
Temporomandibular joints:
The TMJ is palpated bilaterally just anterior to the auricular
tragic while having the patient open and close his lower jaw.
Tenderness, clicking or pain on movement is noted. Maximum
jaw opening less than 40mm indicates jaw restriction, because the
average opening is greater than 50mm. Any deviation from the midline
is also recorded. Maximum lateral movement can be measured (normal
is about 12mm).
Muscles of mastication
A brief palpation of masseter, temporalis, medial pterygoid,
lateral pteregoid, trapezius and sternocleido mastoid muscles may reveal
tenderness. The patient may demonstrate limited opening due to spasm
of the masseter or temporalis, muscle.
Lips:
Next, the patient is observed for tooth exposure during normal
and exaggerated smiling. This may be critical in treatment planning and
particularly for margin placement of metal-ceramic crowns.
5

6. INTRAORAL EXAMINATION
- First the patient’s general oral hygiene is observed.
- The presence or absence of inflammation should be noted along
with gingival architecture and stippling. The existence of pockets
should be entered in the record and their location and depth
chartered.
- The presence and amount of tooth mobility should be recorded
with special attention paid to any relationship with occlusal
prematurities and to potential abutment teeth.
- Check for a band of attached gingiva around all the teeth,
particularly around teeth to be restored with crowns. Mandibular
3rd
molars frequently do not have attached gingiva around the
distal segment (30% to 60% of cases).
- The presence and location of caries is noted. The amount and
location of caries, coupled with an evaluation of plaque retention,
can offer some prognosis for new restorations that will be placed.
It will also help the preparation designs to be used.
- Finally an evaluation should be made of the occlusion. The
amount of slide between the retruded position and the position of
maximum intercuspation should be noted. Non-working
interferences if present, should be evaluated. The presence or
6

7. absence of simultaneous contact on both sides of the mouth
should be observed.
DIAGNOSTIC CASTS
Articulated diagnostic casts are essential in planning fixed
prosthodontic treatment. They provide critical information not directly
available during the clinical examination, static and dynamic
relationships of the teeth can be examined without interference from
protective neuromuscular reflexes. They also reveal those aspects of
occlusion not detectable within the confines of the mouth.
To accomplish their intended goal, they must be accurate
reproductions of the maxillary and mandibular arches made from
distortion free alginate impressions. (The casts should contain no
bubbles as a result of faulty pouring, nor positive nodules on the
occlusal surfaces ensuing from air entrapment during the making of the
impression).
The diagnostic casts should be mounted on a semiadjustable
articulator with a face bow. By the use of lateral interocclusal records or
check bites, a reasonably accurate simulation of jaw movements will be
possible. It is important that the mandibular cast be set in a relationship
determined by the patient’s optimum condylar position (centric relation
position).
7

8. Advantages of diagnostic casts:
1) For diagnosing problems and arriving at a treatment plan.
2) Allow an unobstructed view of the edentulous spaces and an
accurate assessment of the span length, as well as occlusogingival
dimension.
3) Curvature of the arch in the edentulous region can be determined
so that it will be possible to predict whether the pontic/pontics will
act as a lever arm on the abutment teeth.
4) Length of the abutment teeth can be accurately gauged to
determine which preparation designs will provide adequate
retention and resistance.
5) The true inclination of the abutment teeth will also became evident,
so that the problems in a common path of insertion can be
anticipated.
6) Mesiodistal drifting, rotation and faciolingual displacement of
prospective abutment teeth can be clearly seen.
7) A thorough evaluation of wear facets – their number, size and
location is possible.
8

9. 8) Discrepancies in the occlusal plane become very apparent on the
articulated casts.
9) Occlusal discrepancies can be evaluated and the presence of centric
prematurities or excursive interferences can be determined.
10) Teeth that have supraerupted into the opposing edentulous spaces
are easily spotted and the amount of correction needed can be
determined.
11) Diagnostic wax-up can be carried out in situations calling for the
use of pontics which are wider or narrower than the teeth that
would normally occupy the edentulous space.
Full-mouth Radiographs
Radiographs provide the information to help correlate all the facts
that have been collected in listening to the patient, examining the mouth
and evaluating the diagnostic casts.
- Radiographs should be examined carefully for signs of
caries, both on unrestored proximal surfaces and recurring
around previous restorations.
9

10. - The presence of periapical lesions, as well as the existence
and quality of previous endodontic treatments, should be
noted.
- General alveolar bone levels, with particular emphasis on
prospective abutment teeth should be observed.
- The crown-root ratio of abutment teeth can be calculated.
The length, configuration and direction of these roots
should also be examined.
- Any widening of periodontal ligament should be
correlated with occlusal prematurities or occlusal trauma.
- Any evaluation of the thickness of cortical plate of bone
around the teeth and of the bone trabeculae can be made.
- The presence of retained root tips or other pathosis in the
edentulous areas should be recorded.
Vitality Testing
Prior to any restorative treatment, pulpal health must be assessed,
usually by measuring the response to percussion and thermal and
electrical stimulation. A diagnosis of non-vitality can be confirmed by
preparing a test cavity before the administration of local anesthetic.
10

11. SELECTION OF AN ARTICULATOR
A distinction must be made between mounting for diagnosis and
mounting for treatment. The attachment of casts to an articulator for
diagnosis will be done with the condyles in a centric relation position.
Also when the casts are articulated for restoration of a significant
portion of occlusion, it may also be done with condyles in centric
relation position. Mounting casts for restoration of only a small part of
occlusion will be done with teeth in a portion of maximum
intercuspation.
Articulators vary widely in the accuracy with which they
reproduce the movements of the mandible.
1) At the lower end of scale is a non-adjustable articulator. It is
usually a small instrument that is capable of only a hinge
opening. The distance between the teeth and the axis of rotation
on the small instrument is considerably shorter than in the skull
with a resultant loss of accuracy. Drastic differences between the
radius of closure on the articulator and in the patient’s mouth can
affect the placement of morphologic featuers such as cusps,
ridges and grooves on the occlusal surface of the teeth being
restored.
11

12. 2) A semi-adjustable articulator is an instrument whose larger size
allows a close approximation of anatomic distance between the
axis of rotation and the teeth. If the casts are mounted with a
facebow using no more than an approximate transverse horizontal
axis, the radius of movement produced on the articulator will
reproduce the arc of closure with relative accuracy and any
resulting error will be slight. The semiadjustable articulator
reproduces the direction and endpoint, but not the intermediate
track of some condylar movements. Inter condylar distances are
not totally adjustable on semiadjustable articulators. They can be
adjusted to small, medium and large configurations. This type of
articulator can be used for the fabrication of most single units and
fixed partial dentures.
3) A fully adjustable articulator is designed to reproduce the entire
character of border movements, including immediate and
progressive lateral translation, and the curvature and direction on
condylar inclination. Intercondylar distance is completely
adjustable. Since this instrument is very expensive and demands
high degree of skill and time, it is used primarily for extensive
treatment, requiring the reconstruction of an entire occlusion.
12

13. (To set the condylar inclinations on a semiadjustable instrument,
interocclusal records or check bites are used, when the interocclusal
record is removed from an arcon articulator, and the teeth are closed
together, the condylar inclination will remain the same. However, when
the teeth are closed on a non-arcon articulator, the condylar inclination
changes, becoming less steep).
Arcon articulators are more widely used because of their
accuracy and the ease with which they disassemble to facilitate the
occlusal waxing required for cast restorations. This feature makes this
type of articulator (arcon) more difficult for arranging denture teeth. The
centric position is less easily maintained when occlusion on all of the
posterior teeth is being manipulated. Therefore the non-arcon instrument
has been more popular for the fabrication of complete dentures.
Locating the transverse hinge axis
To achieve the highest possible degree of accuracy from an
articulator, the casts mounted on it should be closing around an axis of
rotation that is as close as possible to the transverse horizontal axis of
the patient’s mandible.
13

14. A) The most accurate way to determine the hinge axis is by the “trial
and error” method developed by McCollum and Stuart in 1921
(using a kinematic face bow).
B) Arbitrary face bows can also used. But they must have an
acceptable accuracy. Caliper style ear face bows possess a
relatively high degree of accuracy with 75% of the axes located
by it falling within 6mm of the true hinge axis. These face bows
are designed to be self centering, so that little time is wasted in
centering the bite fork and adjusting individual side arms.
TREATMENT PLANNING FOR SINGLE TOOTH
RESTORATIONS
The most common question arising in treatment planning for
single tooth restorations is than in what circumstances should cemented
restorations made from cast metal or ceramic be used instead of
amalgam or composite resin restorations. The selection of the material
and design of the restoration is based on several factors:
1. Destruction of tooth structure: If the amount of destruction
previously suffered by the tooth is such that the remaining tooth
structure must gain strength and protection from the restoration,
14

15. cast metal or ceramic is indicated over amalgam or composite
resin.
2. Plaque control: The use of cemented restoration demands the
institution and maintenance of good plaque-control program to
increase the changes for success of the restoration. Many teeth
are seemingly prime candidates for cast metal or ceramic
restorations, based solely on amount of tooth destruction that has
previously occurred. However, when these teeth are evaluated
from the oral environment, they may in fact be poor risks for
cemented restorations.
3. Retention: Full veneer crowns are unquestionably the most
retentive. However, maximum retention is not nearly as
important for single-tooth restorations as it is for fixed partial
denture retainers. It does become a special concern for short teeth
and removable partial denture abutments.
INTRA CORONAL RESTORATIONS
When sufficient coronal tooth structure exists to retain and
protect a restoration under the anticipated stresses of mastication, an
intracoronal restoration can be employed. Here the restoration itself is
15

16. dependent on the strength of the remaining tooth structure for structural
integrity.
a) Glass ionomer:
i) In small lesions where extension can be kept minimal.
ii) Useful for restoring Class 5 lesions caused by erosion or
abrasion.
iii) Also employed for incipient lesions on the proximal surfaces
of posterior teeth by the use of “tunnel” preparation which
leaves the marginal ridge intact.
iv) Very useful for the restoration of root caries in geriatric and
periodontal patients.
v) Serves as an interim treatment restoration to assist in the
control of a mouth with rampant caries.
b) Composite resin
i) In minor to moderate-lesions in esthetically critical areas.
ii) Due to polymerization shrinkage and insufficient abrasion
resistance, its use on posteriors should be restricted to small
occlusal and mesio-occlusal restorations on first molars.
16

17. c) Simple amalgam
i) Simple amalgam, without pins or other auxiliary retention is
widely used for one-to-three-surface restoration of minor-to-
moderate sized lesions in esthetically non-critical areas.
ii) They are best used when more than half of coronal dentin is
intact.
d) Complex amalgam
i) Augmented by pins or other auxiliary means of retention, it
can be used to restore teeth with moderate to severe lesions, in
which less than half of the coronal dentin remains.
ii) It can be used as a final restoration when a crown is
contraindicated because of limited finances.
Ideally, however, a crown should be constructed over the pin
retained amalgam, using it as a core or foundation restoration.
e) Metal inlay
i) Minor to moderate lesions on teeth where the esthetic
requirements are low can be restored with this restoration.
17

18. ii) Pre-molars should have one intact marginal ridge to preserve
structural integrity.
iii) Additional bulk of the tooth structure found in a molar,
permits the use of this type in a MOD configuration.
f) MOD Inlay:
i) Can be used for restoring moderately large lesions on
premolars and molars with intact facial and lingual surfaces.
ii) It can accommodate a wide isthmus and up to one missing
cusp on a molar.
iii) Cannot be used as a retainer for fixed partial denture.
EXTRA CORONAL RESTORATIONS
If insufficient tooth structure exists to retain the restoration within
the crown of the tooth, an extracoronal restoration, or crown is needed.
a) Partial veneer crown:
i) Leaves one or more axial surfaces unveneered.
ii) It will provide moderate retention and can be used as a
retainer for short span fixed partial dentures.
18

19. b) Full metal crown:
i) To restore teeth with multiple defective axial surfaces or when
less than half of coronal dentin remains.
ii) Provides maximum use restricted to situations, where there
are no esthetic requirements.
c) Metal-ceramic crown
i) Provides maximum retention.
ii) Combines full coverage with good cosmetic result.
d) All-ceramic crown
i) Their use must be restricted to situations likely to produce low
to moderate stress usually used for incisors.
e) Ceramic veneer
i) Produces good cosmetic result on otherwise intact anterior
teeth that are marred by severe staining or developmental
defects restricted to facial surface of the tooth.
19

20. TREATMENT PLANNING FOR REPLACEMENT OF MISSING
TEETH
Several factors must be weighed when choosing the type of
prosthesis to be used in any given situation. Important ones are:
a) Biomechanical factors.
b) Periodontal factors.
c) Esthetics.
d) Financial factors.
e) Patient’s wishes.
Abutment Evaluation
- Abutment teeth are called upon to withstand the forces
normally directed to the missing teeth, in addition to those
usually applied to the abutments.
- Whenever possible an abutment should be a vital tooth.
However, a tooth that has been endodontically treated
which is asymptomatic with radiographic evidence of a
good seal and complete obturation of the canal, can be
used as an abutment. If the endodontically treated tooth
does not have sound tooth structure, it must treated
20

21. through the use of a dowel core, or a pin-retained amalgam
or composite resin core.
- Teeth that have been pulp capped in the process of
preparing the tooth should not be used as FPD abutments
unless they are endodontically treated.
- The supporting tissues surrounding the abutment teeth
must be healthy and free from inflammation before any
prosthesis can be contemplated.
- Normally, abutment teeth should not exhibit mobility,
since they will be carrying an extra load.
The roots and their supporting tissues should be evaluated for 3 factors:
1. Crown-root ratio.
2. Root configuration.
3. Periodontal ligament area.
1) Crown root ratio
It is a measure of the length of the tooth occlusal to the alveolar
crest of bone compared with the length of the root embedded in the
bone. As the level of the alveolar bone moves apically, the lever arm of
21

22. that portion out of bone increases and the chance for harmful lateral
force is increased.
- The optimum crown-root-ratio for a tooth to be utilized as
a fixed partial denture is 2:3 and a 1:1 ratio is the
minimum acceptable under normal circumstances.
- However, there are situations in which a crown-root-ratio
greater than 1:1 (i.e. length of crown greater than length of
the tooth) may be considered adequate. If the occlusion
opposing a proposed fixed partial denture is comprised of
artificial teeth, occlusal force will be diminished, with less
stress on abutment teeth.
Studies by Klaffenbach in 1936 have shown that occlusal
forces exerted against prosthetic appliances has been
shown to be considerably less than that against natural
teeth.
FPD against RPD  26.0lb
FPD against FPD  54.4 lb
FPD against natural teeth  150.0lb
22

23. 2) Root configuration
- Roots that are broader labiolingually are preferable to
roots that are round in cross section.
- Multirooted posterior teeth with widely separated roots
will offer better periodontal support than roots that
converge, fuse or generally present a conical
configuration. The tooth with conical roots can be used as
an abutment for a short span fixed partial denture if all
other factors are optimal.
- A single rooted tooth with evidence of irregular
configurations or with some curvature in the apical third is
preferable to the tooth that has a nearly perfect taper.
3) Periodontal ligament area:
- Larger teeth have greater surface area and are better able
to bear added stress.
- Kalkwarf in 1986 showed that millimeter per millimeter,
the loss of periodontal support from root resorption is only
1
/3 to ½ as critical as the loss of alveolar crestal bone.
23

24. - Johnston et al in 1971 in their statement designated as
“Ante’s law” said that the root surface area of the
abutment teeth had to equal or surpass that of the teeth
being replaced with pontics.
- Fixed partial dentures with short pontic spans have a better
prognosis than those with long spans. Failures with long
span bridges have been attributed to leverage and torque
than overload. Biomechanical factors and material failure
play an important role in the failure for long span
restorations.
- There is evidence that teeth with poor periodontal support
can serve successfully as fixed denture abutments in
carefully selected cases. Nyman S, Lindhe in 1976 said
that teeth with severe bone loss and marked mobility can
be used as fixed partial denture and splint abutments.
Elimination of mobility is not the goal in such cases, but to
prevent further increase in mobility of that tooth. They
said that this is possible in highly motivated patients who
are proficient in plaque removal.
24

25. Biomechanical Considerations
All fixed partial dentures, long or short spanned bend and flex.
- Bending or deflection varies directly with the cube of the
length and inversely with the cube of occlusogingival
thickness of the pontic.
- Compared with a fixed partial denture having a single
tooth pontic span, a two tooth pontic span will bend 8
times as much. A three tooth pontic will bend 27 times as
much as a single pontic.
- A pontic with a given occlusogingival dimension will
bend 8 times if the pontic thickness is halved. To minimize
flexing caused by long/short spans, pontic designs with a
greater occlusogingival dimension should be selected. The
prosthesis may also be fabricated of an alloy with a higher
yield strength, such as nickel-chromium.
- The dislodging forces of a fixed partial denture retainer
tend to act in a mesiodistal direction, as opposed to the
more common buccolingual direction of forces on a single
restoration. Preparations should be modified accordingly
25

26. to produce greater resistance and structural durability.
Multiple grooves, including some on buccal and lingual
surfaces are commonly employed for this purpose.
- Double abutments are sometimes used as a means of
overcoming problems created by unfavourable crown-root
ratios and long span. There are several criteria that must be
met, if a secondary abutment is to strengthen the fixed
partial denture.
a) A secondary abutment must have atleast as much
root surface area and as favourable a crown-root
ratio as the primary abutment.
E.g.: A canine can be used as a secondary abutment
to a first premolar primary abutment, but it would be
unwise to use a lateral incisor as a secondary
abutment to a canine primary abutment.
- Arch curvature has its effects on the stresses occurring in a
fixed partial denture. When the pontics lie outside the
intraabutment axis line, the pontics act as a lever arm
which can produce a torquing movement. This is a
common problem in replacing all 4 maxillary incisors with
26

27. a fixed partial denture. The best way to offset this torque is
by gaining additional retention in the opposite direction of
the lever arm. The secondary retention must be at a
distance equal to the length of the lever arm from the
interabutment axis.
- E.g.: The first pre-molars some times are used as
secondary abutments for maxillary four-pontic canine-to-
canine FPD.
SPECIAL PROBLEMS
A) Pier abutments: An edentulous space can
occur on both sides of a tooth, creating a lone, freestanding pier
abutment. Physiologic tooth movement, arch position of the
abutments and a disparity in the retentive capacity of the retainers
can make a rigid 5-unit fixed partial denture as a less than ideal plan
of treatment.
- It has been theorized that forces are transmitted to the
terminal retainers as a result of the middle abutment acting
as a fulcrum, causing failure of the weaker retainer.
However a photoelastic stress analysis study conducted by
27

28. Standlee and Caputo in 1988 has shown that the prosthesis
bends rather than rocking.
- The retention on the smaller anterior tooth is usually less
than that of the posterior tooth because of its smaller
dimensions. The loosened casting will leak around the
margin and caries is likely to become extensive before
discovery.
- The use of a non-rigid connector has been recommended
to reduce this hazard. The movement in a non-rigid
connector is enough to prevent the transfer of stresses
from the segment being loaded to the rest of the FPD.
- The most commonly used non-rigid design is a T shaped
key that is attached to the pontic and a dove tail key way
placed within a retainer.
- The key way of the connector should be placed within the
normal distal contours of the pier abutment and the key
should be placed on the mesial side of the distal pontic.
B) Tilted Molar Abutments
28

29. A common problem that occurs is the mandibular second molar
abutment that has tilted mesially into the space formerly occupied by the
first molar. There is further complication if 3rd
molar is present. It will
usually have drifted and tilted with the 2nd
molar.
- If the encroachment is slight, the problem can be remedied
by restoring or recontouring the mesial surface of the third
molar with an overtapered preparation on the second
molar.
- If the tilting is severe, other corrective measure will have
to be followed. The treatment of choice is uprighting of
the molar by orthodontic treatment. The third molar if
present is often removed to facilitate the distal movement
of the 2nd
molar. After removal of the appliance, the teeth
are prepared and a temporary FPD is fabricated to prevent
post treatment relapse.
- A proximal half crown can be used as a retainer on the
distal abutment. This preparation design is a 3 ¼ crown
that has been rotated 90°. It can be used only if the distal
surface is untouched by caries.
29

30. - A telescoping crown and coping can also be used as a
retainer for the tilted molar. A full crown preparation with
heavy reduction is made to follow the long axis of the
tilted molar. An inner coping is made to fit the tooth
preparation. The proximal half crown that will serve as the
retainer for the FPD is fitted over the coping.
- A non-rigid connector is another solution to the problem.
A full crown preparation is done on the tilted molar, with
its path of insertion parallel with the long axis. A box form
is placed on the distal surface of the premolar to
accommodate a keyway in the distal of the premolar
crown.
C) Canine Replacement Fpds
This is a problem because often the canine lies outside the
interabutment axis. The abutments are the lateral incisor, usually the
weakest in the entire arch and the first premolar, the weakest posterior
tooth. A FPD replacing maxillary canine is subjected to more stress
than that replacing a mandibular canine, since forces are transmitted
outward on the maxillary arch. So the support from secondary
abutments will have to be considered. An edentulous space created by
30

31. the loss of a canine and any 2 contiguous teeth is better restored with a
removable partial denture.
D) Cantilever FPDs
A cantilever FPD is one that has an abutment or abutments at one
end only, with the other end of the pontic remaining unattached. This is
a potentially destructive design with the lever arm created by the pontic.
- Abutment teeth for cantilever FPDs should be evaluated
for lengthy roots with a favourable configuration, good crown
root ratios and long clinical crowns.
- Generally, cantilever FPDs should replace only one tooth
and have atleast 2 abutments.
- A cantilever can be used for replacing a maxillary lateral
incisor with canine as the abutment. There should be no occlusal
contact on the pontic in either centric or lateral excursions.
- A cantilever pontic can also be used to replace a missing
1st
premolar with second premolar and 1st
molar as abutment. The
occlusal contact should be limited to the distal fossa on the 1st
premolar pontic.
31

32. - Cantilever FPDs can also be used to replace molars when
there is no distal abutment present. Most commonly the 1st
molar
is replaced with the 2 premolars as abutments. The pontic should
have maximum occlusogingival height, there should be light
occlusal contact on the pontic with no contact in any excursions.
Buccolingual width should be kept minimum and the pontic
should resemble more of a premolar.
32

33. Conclusion
The scope of fixed prosthodontic treatment can range from the
restoration of a single tooth to the rehabilitation of the entire occlusion.
Single teeth can be restored to full function and improvement in
cosmetic effect can be achieved. Missing teeth can be replaced with
fixed prosthesis that will improve patient comfort and masticatory
ability, maintain the health and integrity of the dental arches, in many
instances elevate the patient’s self image.
It is also possible by the use of fixed restorations, to render
supportive and long range corrective measures for the treatment of
problems related to the temporomandibular joint and its neuromuscular
system. On the other hand, with improper treatment of the occlusion it is
possible to create disharmony and damage to the stomatognathic system.
Bibliography
1) Kalkwarf K.L., Krejci R.F., Pao Y.C. : Effect of root
resorption on periodontal support. J.P.D. 1986; 56: 317-319.
2) Malone W.F.P., Koth D.L., Cavazos E. : Tylman’s theory
of practice of fixed prosthodontics. 8th
Ed., Ishiyaku publications,
1977.
33

34. 3) Markley M.R. : Broken-stress principle and design in
fixed prosthesis. J.P.D., 1951; 1: 416-423.
4) Reynolds J.M. : Abutment selection for fixed
prosthodontics. J.P.D., 1968; 19: 483-488.
5) Rosenstiel R.F., Land M.F., Fujimoto J. : Contemporary
fixed prosthodontics. 1st
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