Fiber-reinforced composite fixed dental prostheses: A 4-year prospective clinical trial evaluating survival,quality, and effects on surrounding periodontal tissues

Statement of problem

Although fiber-reinforced composite fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth, comparatively few prospective clinical trials (PCT) exist.

Five-year survival of 3-unit fiber-reinforced composite fixed partial dentures in the anterior area

ObjectivesThe purpose of this clinical study was to evaluate the long-term outcome of 3-unit anterior fixed partial dentures (FPDs) made of fiber-reinforced resin composite (FRC), and to identify design factors influencing the survival rate.Methods52 patients (26 females, 26 males) received 60 indirectly made FRC FPDs, using pre-impregnated unidirectional glass fibers, requiring manual wetting, as framework material. FPDs were surface (n = 48) or hybrid (n = 12) retained and mainly located in the upper jaw. Hybrid FPDs had a combination of retainers; i.e. crown at one and surface retention at the other abutment tooth. Surface FPDs were either purely adhesively retained (n = 29) or with additional mechanical retention (n = 19). Follow-up period was at minimum 5 years, with check-ups every 1–2 years. Six operators were involved, in three centers in the Netherlands, Finland and Sweden. Survival rates, including repairable defects of FPDs, and success rates were determined.ResultsKaplan–Meier survival rate at 5 years was 64% (SE 7%). For the level of success, values were 45% (SE 7%) and the estimated median survival time 58 (SE 10.1) months. For surface FPDs, additional mechanical retention did not improve survival significantly. There was a trend towards better survival of surface FPDs over hybrid FPDs, but differences were not significant. Main failure modes were fracture of the FPD and delamination of veneering composite.SignificanceA success rate of 45% and a survival rate of 64% after 5 years was found. Fracture of the framework and delamination are the most prevalent failure modes, especially for surface FPDs.     

Success,clinical performance and patient satisfaction of direct fibre‐reinforced composite fixed partial dentures – a two‐year clinical study

To evaluate the success, clinical performance and patient satisfaction of directly placed fibre‐reinforced composite (FRC) fixed partial dentures (FPDs) in 2 years. One hundred sixty‐seven FRC FPDs (120 subjects) were directly fabricated to restore a single missing tooth by six Advanced Education in General Dentistry (AEGD) residents. The FRC FPDs recipients were rando‐mised into two groups according to the fibre materials (pre‐impregnated glass or polyethylene). Clinical performance was evaluated at baseline (2 weeks), 6, 12 and 24 months by two calibrated evaluators for prosthesis adaptation, colour match, marginal discoloration, surface roughness, caries and post‐operative sensitivity using modified United State Public Health Service (USPHS) criteria. Prosthesis appearance, colour, chewing ability and overall satisfaction were evaluated by patients using a visual analogue scale (VAS). Kaplan–Meier estimation was used to estimate the prosthesis success. Ninety‐four patients with 137 FRC FPDs returned (21·67% attrition rate for study subjects, 17·94% for FRC FPDs). Seventeen FRC FPDs failed, due to one‐end (n = 4) or two‐ends (n = 4) debonding or pontic fracture (n = 9). The cumu‐lative 2‐year success rate was 84·32% and survival rate was 92·7%; there were no statistically significant differences between the groups according to different missing tooth location, retention type or fibre materials (P > 0·05). Patient satisfaction regarding prosthesis appearance, col‐our, chewing ability and overall satisfaction was rated high on the VAS (mean >80 mm) for all criteria at all time points. The FRC FPDs (restoring single tooth) fabricated by AEGD residents achieved acceptable success and survival rates in a 2‐year follow‐up.     

Comparison of load-bearing capacity of direct resin-bonded fiber-reinforced composite FPDs with four framework designs

OBJECTIVES: This in vitro study was aimed to compare the fracture resistance of directly fabricated inlay-retained fiber-reinforced composite (FRC) fixed partial dentures (FPDs) with four types of framework designs. METHODS: Forty-eight directly fabricated inlay retained FPDs were made of FRC and particulate resin composite (everStick/Tetric flow and Ceram). Extracted human mandibular first premolars and first molars were as abutments. The following framework designs were tested: in the Group A (control group), the framework was made of two prepregs of unidirectional glass FRC; the Group B, two prepregs in pontic portion were covered with one layer of multidirectional fiber veil FRC; the Group C, the FRC prepregs were covered in pontic portion with four short unidirectional FRC pieces along the main prepregs; in Group D, one short unidirectional FRC prepregs were placed on the main prepregs in 90 degrees angle to the main framework. After thermal cycling, FPDs of each group (n=12) were randomly divided into two subgroups (n=6). Fracture test was performed at the universal testing machine (1mm/min) where FPDs were loaded from the occlusal direction to the occlusal fossa or to the buccal cusp. Failure patterns were observed with stereomicroscope. Median and 25%/75% percentile values were calculated and nonparametric analysis was performed. RESULTS: Compared with three other framework designs, the FPDs in Group D showed the highest resistance when loading to the occlusal fossa, with maximum load of 2,353.8N (25%/75%: 2,155.5/2,500.0) (p=0.000, 0.000, and 0.005 for compared with Group A, B, and C). The same group showed also higher resistance when loaded to the buccal cusp (1,416.3N (1,409.2/1,480.8)) if compared to the FPDs of the Group A and Group C (p=0.044, 0.010). In general the FPDs showed higher resistant to loading at the occlusal fossa (p<0.05). CONCLUSIONS: This in vitro study showed that inlay-retained FRC FPD constructed with direct technique provided high fracture resistance. The framework design that provided support for the veneering composite of the pontic contributed to the highest load-bearing capacity even when loaded to the buccal cusp.     

Fracture resistance of inlay-retained fixed partial dentures reinforced with fiber-reinforced composite

In this study, the effect on the fracture load of inlay-retained composite fixed partial dentures (FPDs) caused by reinforcing them with fiber-reinforced composite (FRC) in different positions was examined. Experimental FPDs were fabricated using Estenia/EG Fiber (Kuraray Medical). Pontic reinforcement was then performed in one of the following three ways: reinforced the central area in a single line or in double straight lines, or reinforced the bottom in a curved line. The finding was that, when the area ranging from the connector to the bottom of the pontic was reinforced with FRC in a curved line, the fracture load of the FPDs tended to become higher. In addition, the FPDs fractured mainly at the veneering composite of the connector area. Based on the results of this study, it was concluded that reinforcement using FRC is effective, and that the veneering composite in the connector area needs to have sufficient strength to prevent the fractures.     

Experimental design of FPD made of all-ceramics and fibre-reinforced composite.

OBJECTIVES: This study was carried out to combine flexural properties of FRC materials with aesthetic values of ceramics. METHODS: The bonding strength of fibre-reinforced composite to ceramic was determined. Afterwards, 8 three unit and 8 four unit FPDs (fixed partial dentures) were manufactured based on the experimental design and were then adhesively luted onto human molars. After thermal cycling and mechanical loading in an artificial environment, the fracture strength and marginal adaptation was determined. FPDs made of FRC (fibre-reinforced composite) materials were used as a control. RESULTS: The most reliable bonding strength of ceramic to FRC material was achieved using acid etching in combination with adhesive luting techniques. Median fracture strength values of 575 N for three unit FPD and 876 N for four unit FPD were established. More than 85% of the experimental FPDs showed a perfect margin while less than 15% revealed a marginal gap, even after thermal cycling and mechanical loading (TCML). The strongest influence of TCML on the marginal adaptation of the experimental design FPD was determined within the four unit system showing approximately a 10% change in marginal gap and perfect margin. SIGNIFICANCE: Assuming an improvement in adhesive bonding between the ceramic and the FRC material and, in addition, an enhancement of the contact surface between pontic and abutment, the hybrid technique could represent an interesting procedure for further investigations and, eventually, clinical implication.     

A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years

OBJECTIVES: The objective of this systematic review was to assess the 5- and 10-year survival of implant supported fixed partial dentures (FPDs) and to describe the incidence of biological and technical complications. METHODS: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. RESULTS: The search provided 3844 titles and 560 abstracts. Full-text analysis was performed for 176 articles resulting in 21 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants in implant-supported FPDs of 95.4% (95 percent confidence interval (95% CI): 93.9-96.5%) after 5 and 92.8% (95% CI: 90-94.8%) after 10 years. The survival rate of FPDs supported by implants was 95% (95% CI: 92.2-96.8%) after 5 and 86.7% (95% CI: 82.8-89.8%) after 10 years of function. Only 61.3% (95% CI: 55.3-66.8%) of the patients were free of any complications after 5 years. Peri-implantitis and soft tissue complications occurred in 8.6% (95% CI: 5.1-14.1%) of FPDs after 5 years. Technical complications included implant fractures, connection-related and suprastructure-related complications. The cumulative incidence of implant fractures after 5 years was 0.4% (95% CI: 0.1-1.2%). After 5 years, the cumulative incidence of connection-related complications (screw loosening or fracture) was 7.3% and 14% for suprastructure-related complications (veneer and framework fracture). CONCLUSION: Despite a high survival of FPDs, biological and technical complications are frequent. This, in turn, means that substantial amounts of chair time have to be accepted by the clinician following the incorporation of implant-supported FPDs. More studies with follow-up times of 10 and more years are needed as only few studies have described the long-term outcomes.     

Fixed partial dentures: all-ceramics,fibre-reinforced composites and experimental systems

The aim of this in vitro study was to compare the fracture strength of three-unit FPDs (fixed partial dentures) and three-unit inlay FPDs after a simulated 5-year oral wearing period. The restorations were made of a pressable all-ceramic (Empress 2) and two specially designed, experimentally fixed partial dentures combining ceramics with dental composite. Three-unit FPDs and inlay FPDs were manufactured and were adhesively luted onto human molars. After thermal cycling and mechanical loading in an artificial environment, the fracture strength was determined. Zircon-based milled ceramic (Lava) three-unit FPDs were used as a control. The zircon ceramic and the fibre-based ceramic three-unit FPDs showed median fracture values between 1000 and 1400 N. For composite veneered zircon FPDs a fracture strength of about 800 N and for all-ceramic Empress 2 of about 350 N could be determined. The results for the inlay FPDs were between 1300 N and 1400 N for FRC/ceramic, 1000 N for zircon/composite and 500 N for all-ceramic restorations. The all-ceramic showed higher fracture resistance applied as inlay FPDs. The described hybrid techniques combining ceramics and composites could represent an interesting procedure for further investigations and, eventually, clinical implication.     

Risk of chipping or facings failure of metal ceramic fixed partial prostheses—a retrospective data record analysis

This retrospective study investigated the frequency and time history of chipping or facings failure of three-unit and four-unit tooth-supported metal ceramic (MC) fixed partial prostheses (FPDs). Six hundred fifty-four MC FPDs were inserted according to a standardized treatment protocol at the Department of Prosthodontics of the Regensburg University Medical Center between 1984 and 2009. Frequency and time history of chipping or facings failure as well as possible risk factors were evaluated on the basis of historical clinical data. We estimated the survival times of FPDs by means of the Kaplan–Meier analysis. The 5-year survival rate (time to renewal of a FPD) of all MC FPDs was 94%; the 10-year survival rate was 87%. Twenty-eight (4.3%) MC FPDs showed chipping; the 5-year free-of-event rate of chipping was 95%, the 10-year rate was 94%. Possible risk factors had no statistically significant influence on chipping or facings failure. The annual hazard rate of MC chipping in the first year was 0.03, i.e., 3 out of 100 person-years of exposure showed chipping. The annual hazard rates for the next 6 years dropped to 0.009, 0.003, 0.007, 0.004, 0.005, and 0.007. Thus, about 3–9 out of 1,000 person-years of exposure showed chipping. Patients with MC FPD may expect a long survival rate of their restoration. During the first year, the risk of chipping may be higher than during the following years. Despite the long period of experience with MC FPDs, chipping of the facing will still occur.     

A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth--implant-supported FPDs

OBJECTIVES: The objective of this systematic review was to assess the 5- and 10-year survival of combined tooth-implant-supported fixed partial dentures (FPDs) and the incidence of biological and technical complications. METHODS: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. RESULTS: From a total of 3844 titles and 560 abstracts, 176 articles were selected for full-text analysis, and 13 studies met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants in combined tooth-implant-supported FPDs of 90.1% (95 percent confidence interval (95% CI): 82.4-94.5%) after 5 and 82.1% (95% CI: 55.8-93.6%) after 10 years. The survival rate of FPDs was 94.1% (95% CI: 90.2-96.5%) after 5 and 77.8% (95% CI: 66.4-85.7%) after 10 years of function. There was no significant difference in survival of tooth and implant abutments in combined tooth-implant FPDs. After an observation period of 5 years, 3.2% (95% CI: 1.5-7.2%) of the abutment teeth and 3.4% (95% CI: 2.2-5.3%) of the functionally loaded implants were lost. After 10 years, the corresponding proportions were 10.6% (95% CI: 3.5-23.1%) for the abutment teeth and 15.6% (95% CI: 6.5-29.5%) for the implants. After a 5 year observation period, intrusion was detected in 5.2% (95% CI: 2-13.3%) of the abutment teeth. Intrusion of abutment teeth were almost exclusively detected among non-rigid connections. CONCLUSION: Survival rates of both implants and reconstructions in combined tooth-implant-supported FPDs were lower than those reported for solely implant-supported FPDs (Pjetursson et al. 2004). Hence, planning of prosthetic rehabilitation may preferentially include solely implant-supported FPDs. However, anatomical aspects, patient centered issues and risk assessments of the residual dentition may still justify combined tooth-implant-supported reconstructions. It was evident from the present search that tooth-implant-supported FPDs have not been studied to any great extent and hence, there is a definitive need for more longitudinal studies examining these reconstructions.     

Fracture strength of fiber-reinforced surface-retained anterior cantilever restorations

PURPOSE: This study compared the fracture strength of direct anterior cantilever fiber-reinforced composite (FRC) fixed partial dentures (FPD) reinforced with 3 types of E-glass fibers preimpregnated with either urethane tetramethacrylate, bisphenol glycidylmethacrylate/polymethyl methacrylate, or bisphenol glycidylmethacrylate monomers and 1 ultrahigh molecular weight polyethylene fiber. Failure types were also evaluated. MATERIALS AND METHODS: A total of 40 caries-free, human maxillary central incisors (n = 10 per group) received surface-retained direct cantilever restoration (1 pontic) after etching and application of bonding agent. Four FRC materials were used (FRC1 = EverStick; FRC2 = BR-100; FRC3 = Interling; FRC4 = Ribbond), and pontics were built up using 1 particulate filler composite (Clearfil Photo Posterior). After the fracture test, failure types were analyzed. RESULTS: No significant difference was found between the 4 FRC types veneered with particulate filler composite (893 +/- 459 N to 1326 +/- 391 N) (P = .1278). Complete pontic fracture at the connector area was most prominent for FRC4 (90%), followed by FRC3 (70%). Only FRC2 (10%) showed some fiber fractures, with half of the fiber remaining attached on the enamel surface of the abutment. CONCLUSION: The fracture strengths of cantilever FPDs made of 4 FRC materials with different monomer matrices and architectures, veneered with particulate filler composite, did not show significant differences. However, failure behavior varied between groups.     

Implant supported fixed partial dentures survival rate high, but biological and technical complications common

DATA SOURCES: PubMed (1966-April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. Manual search of eight relevant journals (published 2001-2003) provided a further source of data. STUDY SELECTION: As there were no randomised controlled trials comparing implant therapy with conventional reconstructive dentistry, English language prospective and retrospective cohort studies were selected if; they had a mean follow-up of >/=5 years; included patients who were clinically examined at follow-up; reported details on suprastructures and described at least one-third of reconstructions as fixed partial dentures (FPDs). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened articles for inclusion. Disagreements were resolved by discussion and agreement determined by kappa. Data were extracted on the survival proportions of the reconstructions and on biological and technical complications. Biological complications included disturbances in the function of the implant characterized by a biological process affecting the supporting tissues. Technical complications denoted mechanical damage of implants, implant components, or the suprastructures. The number of events for all categories was identified and the corresponding total exposure time of the reconstruction calculated. Failure and complication rates were calculated by dividing the number of events by the total exposure time. RESULTS: Twenty-one studies of implant supported FPDs, reporting on 16 patient cohorts were included. Of the studies, 16 were prospective and five retrospective. A total of 1336 FPDs supported by 3578 oral implants were involved. Meta-analyses gave an estimated implant survival of 95.4% (95% CI 93.9-96.5) after 5 years and 92.8% (95% CI 90-94.8) after 10 years. Implant failure rate was 48% lower (P=0.006) in the more recent studies. The estimated survival for the FPDs was 95% (95% CI 92.2-96.8) after 5 years and 86.7% (95% CI 82.8-89.8) after 10 years. Four studies provided information on the number of patients free from complications - after 5 years 61.3% (95% CI 55.3-66.8) had suffered no minor or major complications. A random effects Poisson model revealed the rate of biological complications for patients treated with implant supported FPDs to be 8.6% (95% CI 5.1-14.1) after 5 years. For technical complications the cumulative 5 year complication rate varied from 0.4% for implant fracture to 13.2% for veneer fracture. CONCLUSIONS: Although survival rate for implant supported FPDs is high, biological and technical complications are relatively common.     

90% of fixed partial dentures survive 5 years. How long do conventional fixed partial dentures (FPDs) survive and how frequently do complications occur?

DATA SOURCES: PubMed (1966-April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. STUDY SELECTION: As there were no randomised controlled trials, English language prospective and retrospective cohort studies were selected if they had a mean follow-up of >/=5 years, included patients who were clinically examined at follow-up, reported details on suprastructures and described at least one-third of reconstructions as fixed partial dentures (FPDs). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened articles for inclusion. Disagreements were resolved by discussion and agreement determined by kappa. Three reviewers extracted data on the survival and success of the reconstructions and on biological and technical complications. Studies deemed sufficiently similar by design were pooled using negative binomial regression with robust standard errors. Ten-year survival risks were calculated using exp(-10 x failure rate) and 10-year failure risks using 1-S(10). RESULTS: 17 retrospective and two prospective cohort studies including 1764 patients with 3548 FPDs analyzed in total. Meta-analysis was undertaken and after exclusion of one outlier a 10-year FPD survival of 92% was estimated. Only four studies provided information on FPD success - pooled complication rate was 34.1/1000 FPD years (95% CI 16-74). Exclusion of one outlier resulted in an estimated 10-year success of 81.1%. Considering biological complications, the estimated 10-years risk for caries at abutments was 9.5% (95% CI 4.6-89.9) while that for FPD loss due to caries and periodontal disease were 2.6% (95% CI 1.6-4.2) and 0.5% (95% CI 0.1-2.2), respectively. Estimated 10-year risks for technical complications were: 6.4% (95% CI 3.9-10.4) for loss of retention; 2.1% (95% CI 1.4-3.2) for loss of FPD due to abutment fracture and 3.2% (95% CI 1.5-6.5) for material fractures. CONCLUSIONS: Estimated success and survival rates for conventional FPDs largely confirm those of previous reviews. Technical complications such as loss of retention, which have not been reviewed before, resulted in a greater risk of FPD loss than did biological complications.     

Structural optimization of the fibre-reinforced composite substructure in a three-unit dental bridge

IntroductionFailures of fixed partial dentures (FPDs) made of fibre-reinforced composites (FRC) have been reported in many clinical and in vitro studies. The types of failure include debonding at the composite-tooth interface, delamination of the veneering material from the FRC substructure and fracture of the pontic. The design of the FRC substructure, i.e. the position and orientation of the fibres, will affect the fracture resistance of the FPD.ObjectivesThe purpose of this study was to find an optimal arrangement of the FRC substructure, by means of structural optimization, which could minimize the failure-initiating stresses in a three-unit FPD.MethodsA structural optimization method mimicking biological adaptive growth was developed for orthotropic materials such as FRC and incorporated into the finite element (FE) program ABAQUS. Using the program, optimization of the fibre positions and directions in a three-unit FPD was carried out, the aim being to align the fibre directions with those of the maximum principal stresses. The optimized design was then modeled and analyzed to verify the improvements in mechanical performance of the FPD.ResultsResults obtained from the optimization suggested that the fibres should be placed at the bottom of the pontic, forming a U-shape substructure that extended into the connectors linking the teeth and the pontic. FE analyses of the optimized design indicated stress reduction in both the veneering composite and at the interface between the veneer and the FRC substructure.SignificanceThe optimized design obtained using FE-based structural optimization can potentially improve the fracture resistance of FPDs by reducing some of the failure-initiating stresses. Optimization methods can therefore be a useful tool to provide sound scientific guidelines for the design of FRC substructures in FPDs.     

Studio clinico osservazionale sull’uso di ponti Maryland in composito rinforzato con fibre (FRC): successi e fallimenti in cinque anni

Objectives

This observational study aims to clinically verify the rate of success of Fixed Partial Dentures (FPDs) made of resin and glass fiber composite (Fiber-Reinforced Composite, FRC).

Materials and methods

Our study sample involved 50 subjects (30 males and 20 females) aged between 14 and 45 who have been rehabilitated with FRC Maryland bridges (for a total of 67 FPD-FRC). The observational study was performed for five years following the general rules coded by the modified US Public Health Service (USPHS) system.

Results

After five years of follow-up, seven out of 67 prosthesis (five belonging to the adult group and two belonging to the adolescent group) were found unsuitable. Four of these FPD-FRCs were considered unsuitable because of break of the framework, the remaining three FPDFRCs were regarded unsuitable because of leakage of the marginal seal.

Conclusions

This clinical investigation showed that the FPDs made with FRC technique can be considered a viable alternative to the traditional removable and fixed prosthesis.     

A preliminary prospective evaluation of all-ceramic crown-retained and inlay-retained fixed partial dentures

PURPOSE: The purpose of this preliminary prospective study was to evaluate the clinical outcome of crown-retained and inlay-retained fixed partial dentures (FPDs) made from a new lithium-disilicate glass-ceramic (IPS e.max Press, Ivoclar Vivadent). MATERIALS AND METHODS: Eighty-one 3-unit FPDs were placed in 68 patients. The FPDs replaced teeth in the anterior (8%) and posterior region (92%). All teeth were prepared according to a standardized protocol. The size of the proximal connector of the FPDs was 12 mm2 (anterior) or 16 mm2 (posterior), respectively. Crown-retained FPDs were cemented either with glass ionomer (n = 20) or resin composite (n = 16), while all inlay-retained FPDs (n = 45) were cemented with resin composite. Initial follow-up was performed at 6 and 12 months and annually thereafter. RESULTS: The mean observation periods were 48 months (for crown-retained FPDs) and 37 months (for inlay-retained FPDs). None of the crown-retained FPDs failed during the observation period, while 6 inlay-retained FPDs (13%) had to be replaced. Six cases failed because of debonding (n = 3) or a combination of debonding and fracture (n = 3). During the observation period, 2 patients died and the status of another 5 patients is unknown. The 4-year survival rate according to Kaplan-Meier was 100% for crown-retained FPDs and 89% for inlay-retained FPDs. The differences between the groups were statistically significant. CONCLUSION: Crown-retained 3-unit FPDs made from a new glass-ceramic have a significantly better outcome up to 5 years than inlay-retained 3-unit FPDs over the observation period.     

Conservative inlay fixed partial denture: a clinical and laboratory technique

Fiber-reinforced composite (FRC) fixed partial dentures (FPDs) offer a clinical alternative for the restoration of single missing teeth and short-span posterior and anterior FPDs. This treatment modality is conservative and cost-efficient. The continuous improvement of adhesives and resin-based composite systems makes this type of restoration successful with good esthetic and functional results. This article reports the case of a patient who received an FRC FPD as a treatment modality and illustrates the clinical procedure as well as a new laboratory technique utilizing a clear matrix for the fabrication of the prosthesis.     

An 18-year retrospective analysis of treatment outcomes with metal-ceramic fixed partial dentures

Purpose: The aim of this clinical retrospective study was to evaluate the survival and success rates of metal-ceramic fixed partial dentures (FPDs) made by dental students over an 18-year interval. Biologic and technical complications as well as patient satisfaction were recorded. Materials and Methods: Fifty-seven patients with 82 FPDs from an original group of 104 patients with 128 FPDs attended an approximate clinical 18-year follow-up examination. The mean follow-up period was 17.7 years (range: 17.1 to 21.3 years). Results: Nine FPDs were lost because of extraction of an abutment tooth, and 1 FPD was removed for esthetic reasons. Technical problems recorded included loss of cementation, fractures in the metal framework, and need for placement of a dowel in an abutment tooth. The most common clinical findings were gingival bleeding on probing and appearance of supragingival crown margins. The survival rate of the FPDs was 78%, and the established success rate was 71%. Conclusion: This 18-year follow-up of metal-ceramic FPDs in just over half of the originally treated patient group was associated with good patient satisfaction and few biologic and technical complications. Int J Prosthodont 2011;24:314-319.     

Survival rates of resin-bonded, glass fiber-reinforced composite fixed partial dentures with a mean follow-up of 42 months: a pilot study

STATEMENT OF PROBLEM: Although short-term clinical data exist for resin-bonded, glass fiber-reinforced composite fixed partial dentures (FPDs), long-term data are needed. PURPOSE: The survival rates of 29 resin-bonded, glass fiber-reinforced composite fixed partial dentures were evaluated in this clinical study for periods of up to 42 months. MATERIAL AND METHODS: FPDs were fabricated to replace 1 to 3 missing maxillary or mandibular teeth of 29 patients not able to be treated with conventional FPDs. Originally, there were 37 patients (the drop-out rate was 22%). The FPDs were retained with wings, inlays, complete coverage crowns, or combinations of these that were bonded to tooth structure. The FPD frameworks were made of continuous unidirectional E-glass fibers with a multiphase polymer matrix and light-polymerized particulate composite veneer. The patients were recalled for examinations, where a general dental examination was performed, 1 to 3 times per year for up to 63 months (minimum 24 months, mean 42 months). Partial or complete total debonding of the FPD or the framework fracture was considered a treatment failure. The data were analyzed with the Kaplan-Meier survival test (alpha=.05). RESULTS: Two resin frameworks fractured, and 3 frameworks were debonded. Kaplan-Meier survival probability at 63 months was 75%. Three of the failed FPDs were rebonded or repaired in situ, producing a functional survival rate of 93% after rebonding or repairing (mean survival time was 55 months). CONCLUSION: The results of this clinical study of 29 prostheses suggest that glass fiber-reinforced FPDs may be a possible alternative to cast metal resin-bonded FPDs. These restorations were successfully used as multiple-unit prostheses that employed a variety of abutment tooth preparation designs.     

Post-endodontic restorations with adhesively luted fiber-reinforced composite post systems: a review

PURPOSE: To review the literature on adhesive luting of fiber-reinforced composite posts (FRC) to provide evidence for the clinical procedure of restoring endodontically treated teeth using FRC posts. METHODS: Data focusing on bonding behavior between root canal dentin, luting agent, and FRC post in vitro as well as in vivo performance of teeth restored with FRC posts were reported. These data were identified by searches of "PubMed", "Scopus", and "Cochrane Library" databases with the terms "post-endodontic restoration", "fiber post", "adhesive luting", "root canal dentin", "clinical study", and "pre-treatment fiber post". Papers published up to September 2007 were selected, and most relevant references were chosen. Cross-referencing of significant papers identified additional relevant articles. RESULTS: FRC posts seem to have become increasingly popular for the restoration of endodontically treated teeth. Compared to metal posts, FRC posts revealed reduced fracture resistance in vitro, along with a usually restorable failure mode. Bonding behavior among FRC post, luting agents, and root canal dentin demonstrated varying results. Bond strengths between FRC posts and resin cements can be enhanced by using various pre-treatment procedures; however, bonding to root canal dentin still seems to be challenging. Most clinical studies investigating survival rates of teeth restored with FRC posts revealed promising results, but risk factors (e.g., the loss of coronal tooth structure) have not been studied intensively. In addition, randomized controlled clinical long term trials are scarce.