Replacement of missing teeth in a partially edentulous arch involves various treatment options like removable or fixed prostheses, and implants. Fixed dental prostheses (FDPs) like fixed partial dentures (FPDs) can provide effective solutions for a wide range of dental conditions. As materials and methods have evolved, this restorative method has become increasingly predictable for maintaining function and aesthetics for patients over a long period.
The most common causes of dental bridge failure are divided into categories involving biological, mechanical and aesthetic considerations. Mechanical failures include prosthesis fracture, crown perforation, failed post-retained crowns, defective margins or loss of retention. Biological failure can most commonly occur due to periodontal disease or periapical involvement, but reasons for replacement also include a poor occlusal plane, or caries.[i]
Poor aesthetics are another common reason for failure of a fixed prosthesis, which can be a secondary result of biological or mechanical failure, or due to a poor choice of materials and methods.[ii] When planning and creating the perfect dental bridge, there are several important considerations to ensure beautiful results that last.
Aesthetic considerations for the perfect FDP
The appearance of the bridge plays a significant role, especially for those who need restoration in anterior areas of the mouth. The shade, texture and translucency of the prosthesis, as well as the cement used should match the patient’s natural teeth as closely as possible to ensure a seamless look. It is also important to consider the shape, thickness and contouring of the pontic – not only to ensure the mucosa remains healthy under the bridge, but to have a consistent visual appearance alongside the patient’s natural teeth.[iii]
Overall oral aesthetics
Designing the pontic to mimic the natural emergence profile of the tooth helps in achieving a more natural look. Lack of attention to the emergence profile can result in limited access for oral hygiene, causing inflamed tissue that can lead to an unappealing aesthetic outcome, such as bone loss and gingival recession, which additionally threaten the success of treatment.[iv] Away from the aesthetic region, the pontic should ideally be avoid gingival contact, and be modified for easy cleaning.[v]
Ensuring proper occlusal relationships prevents functional issues and maintains the aesthetic integrity of the restoration. The teeth in the anterior region have a role in phonetics as well as aesthetics. To aid in these two outcomes, a pontic in this region can slightly touch the ridges, and a conical, bullet, or spheroid pontic is recommended.[vi]
Appropriate use of materials
Choosing the restorative material is an important factor for meeting functional as well as aesthetic requirements. While strength of materials may be more important consideration for posterior bridges, in visible areas, bridge materials may require more aesthetic properties to meet patients’ requirements. In addition, they should be resistant to staining from common foods and beverages, such as coffee, tea, or red wine.
Common materials include porcelain, porcelain-fused-to-metal (PFM), or all-metal alloys. Stain-resistant and durable, porcelain can provide a natural look and is often used for bridges in the aesthetic region of the mouth. Porcelain-fused-to-metal offers a strong structure while still looking like natural teeth.
Zirconia is strong, durable all-ceramic material which can provide an excellent aesthetic result. This material is becoming more popular for its similarity to natural teeth. Zirconia crowns can fail – primarily due to biological or technical complications, and can be difficult to remove,[vii] but it remains an important restorative material due to its favourable mechanical and visual properties.[viii]
Non-prep bridges (NPBs) do not require any preparation of the abutment teeth, offering a truly non-invasive solution for patients with healthy abutment teeth and gingiva. These can be applied directly using flowable composite, or using indirect restorations which are bonded. These restorations can be fabricated from blocks of resin composite, or hybrid ceramic materials using CAD/CAM techniques, and can be modelled to blend well with natural teeth, even in anterior areas of the mouth.[ix]
Meeting patient expectations
When treatment with an FDP is preferred, and clinically appropriate, managing the patient’s expectations regarding the aesthetic outcome is important for satisfaction with the final restoration.
Providing the perfect restoration requires a comprehensive approach that takes into account various patient factors, clinical considerations, and aesthetic needs. SoloCem from COLTENE, is a self-adhesive resin cement application with low shrinkage, which is not only fast but also safe. SoloCem has been developed for reliable adhesion combined with excellent aesthetics, for optimal restoration wherever luting is required.
Fixed dental prostheses provide effective solutions for restoring missing teeth; however, they must be carefully chosen and customised for each patient to ensure optimal biological, mechanical, and aesthetic results. Selecting the appropriate materials for adhesion, as well as for the prosthetic itself, is a crucial factor in achieving successful outcomes.
For more on COLTENE, visit https://colteneuk.com/
email info.uk@coltene.com or call 0800 254 5115.
[i] Al Refai R, Saker S. Clinical and Radiographic Assessment of Reasons for Replacement of Metal- Ceramic Fixed Dental Prostheses in Patients Referring to Dental School. J Clin Exp Dent. 2018 Jan 1;10(1):e75-e80. doi: 10.4317/jced.53850. PMID: 29670720; PMCID: PMC5899812.
[ii] Al Refai R, Saker S. Clinical and Radiographic Assessment of Reasons for Replacement of Metal- Ceramic Fixed Dental Prostheses in Patients Referring to Dental School. J Clin Exp Dent. 2018 Jan 1;10(1):e75-e80. doi: 10.4317/jced.53850. PMID: 29670720; PMCID: PMC5899812.
[iii] Kazmi SMR, Iqbal Z, Muneer MU, Riaz S, Zafar MS. Different pontic design for porcelain fused to metal fixed dental prosthesis: Contemporary guidelines and practice by general dental practitioners. Eur J Dent. 2018 Jul-Sep;12(3):375-379. doi: 10.4103/ejd.ejd_232_18. PMID: 30147402; PMCID: PMC6089067.
[iv] Mandal, P., Bhowmick, D., & Nair, V. (2023). Creating Natural Emergence Profile In Maxillary FPD. International Journal, 6(2), 52.
[v] Kazmi SMR, Iqbal Z, Muneer MU, Riaz S, Zafar MS. Different pontic design for porcelain fused to metal fixed dental prosthesis: Contemporary guidelines and practice by general dental practitioners. Eur J Dent. 2018 Jul-Sep;12(3):375-379. doi: 10.4103/ejd.ejd_232_18. PMID: 30147402; PMCID: PMC6089067.
[vi] Kazmi SMR, Iqbal Z, Muneer MU, Riaz S, Zafar MS. Different pontic design for porcelain fused to metal fixed dental prosthesis: Contemporary guidelines and practice by general dental practitioners. Eur J Dent. 2018 Jul-Sep;12(3):375-379. doi: 10.4103/ejd.ejd_232_18. PMID: 30147402; PMCID: PMC6089067.
[vii] Keeling FL, Taft RM, Haney SJ. Bur Choice When Removing Zirconia Restorations. J Prosthodont. 2023; 32: 347–352. https://doi.org/10.1111/jopr.13564
[viii] Fernando Zarone, Simona Russo, Roberto Sorrentino, From porcelain-fused-to-metal to zirconia: Clinical and experimental considerations, Dental Materials, Volume 27, Issue 1, 2011, Pages 83-96, ISSN 0109-5641, https://doi.org/10.1016/j.dental.2010.10.024.
[ix] Staehle HJ. New Methods for Replacing Single Missing Teeth with Non-prep Bridges (NPBs) – A Case Series. J Adhes Dent. 2023 Oct 16;25:195-210. doi: 10.3290/j.jad.b4515555. PMID: 37843502; PMCID: PMC11734248.
