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Próteses adesivas sem metal. Uma revisão de literatura
Abstract
RHBT. Resin bonded bridge. A literature review. Rev Odontol UNESP. 2005; 34(3): 119-128. Resumo: As próteses adesivas surgiram como uma alternativa protética, tendo em vista o seu baixo custo, ser uma técnica mais conservadora e facilidade laboratorial. Mais recentemente, em razão da necessidade de soluções clínicas estéticas, novos materiais foram introduzidos no mercado e utilizados na confecção de próteses adesivas sem metal. Os materiais utilizados são: resinas compostas reforçadas por fibras e sistemas cerâmicos de alta resistência. O objetivo deste trabalho foi discutir, por meio de uma revisão de literatura, as formas de preparo, os tipos de materiais, as vantagens e desvantagens da utilização de próteses adesivas sem metal. Com base nas informações da literatura, pôde-se concluir que as próteses adesivas sem metal são uma alternativa promissora na substituição de um elemento dental devido a sua superioridade estética, biocompatibilidade e facilidade de confecção, principalmente para compósitos reforçados por fibras. Além disso, sua resistência apresenta resultados satisfatórios in vitro. Entretanto, há poucas evidências científicas com relação a formas de preparo ideais para os retentores de ambos os materiais a serem utilizados rotineiramente na clínica. Assim, acompanhamentos longitudinais deveriam ser realizados para verificar o comportamento dessas próteses na cavidade bucal antes que possam ser indicadas como tratamento de rotina na prática clínica diária. Abstract: The resin bonded bridge sets up as prosthodontic alternative based on its cost-effective, conservative techniques and easiness of laboratory manufacturing. Nowadays, the clinical practice has been requiring esthetic solutions and, consequently, new materials have been introduced and used in the metal free resin bonded bridge manufacture. The materials used are fibre-reinforced composite and high-strenght ceramic systems. The purpose of this study was to discuss through a literature review the cavity design, types of materials used and the advantages and disadvantages of the metal free resin bonded bridges. Based on the reviewed literature it could be concluded that the metal free resin bonded bridges are a promising solution for the replacement of a tooth because of their improved esthetics, biocompatibility and simple technique, specialy for the fiber reinforced composite. Moreover, this kind of prosthesis presents satisfactory in vitro strenght results. However, there is little scientific evidence about the adequated cavity and connector designs that offer support to use this prosthesis in clinical routine. Therefore, longitundinal studies should be performed in order to investigate the clinical behaviour of these prosthesis in the oral environment before their indication as a routine modality of treatment.
... Uma opção viável para a reabilitação de um ou dois dentes perdidos é o uso de próteses parciais fixas adesivas, e tais próteses apresentam algumas vantagens, como: os procedimentos e materiais requeridos para a sua execução são de baixo custo (Campanha et al., 2005;Soares et al., 2006;Fonseca et al., 2010;Scanferla et al., 2019), além do fato de o procedimento apresentar uma menor complexidade. ...
... Outra modalidade disponível são as próteses adesivas indiretas, que segundo Campanha et al., (2005), são confeccionadas em laboratório a partir de moldes dos dentes do paciente para serem fixadas com cimento resinoso ou adesivo. Também há a alternativa de uso de próteses adesivas sobre implantes, fixadas nos implantes dentários para substituírem os dentes ausentes, sendo confeccionadas em resina composta ou cerâmica. ...
... Essa técnica oferece vantagens estéticas, funcionais e biológicas (Goyatá et al., 2010;Silva et al., 2020;Felizardo et al., 2016). A técnica é de fácil e rápida execução (Goyatá et al., 2010;Raposo et al., 2013;Campanha et al., 2005), com mínima invasão dos dentes suportes (Santana et al., 2010;Felizardo et al., 2016), em relação às próteses parciais fixas convencionais. ...
A técnica de prótese adesiva consiste em utilizar materiais que se aderem aos dentes para substituir dentes ausentes, sem necessidade de desgastar muito os dentes que servem de apoio. Um desses materiais é a resina composta reforçada por fibra de vidro, que se adapta e se fixa bem à prótese adesiva. Neste caso clínico, foi realizada uma prótese parcial fixa adesiva, usando os dentes vizinhos como suporte para uma prótese unitária feita de resina composta reforçada por fibra de vidro. O propósito foi devolver a função e a estética do dente 25, sem gerar desconforto ao paciente. Os procedimentos foram feitos assegurando que a prótese ficasse bem ajustada na boca da paciente, e a técnica consistiu em colocar resina composta no dente preparado, com uma fibra de vidro entrelaçada em forma de X sobre a resina. A polimerização prendeu a fibra de vidro ao dente, aumentando a resistência da prótese adesiva, o que possibilitou evitar preparos invasivos e reduzir riscos de fraturas e deslocamentos das próteses adesivas. Os resultados obtidos através do tratamento, consistem na melhoria da capacidade de mastigação e a confiança da paciente. No caso, a fibra de vidro reforçou a prótese adesiva, devolvendo a estética e função dos dentes, com boa adaptação e estabilidade, e as vantagens incluíram a preservação da estrutura dental saudável e a restauração da função estética.
... Deste modo, a recuperação de dentes perdidos pode melhorar autoestima, autoconfiança, a sociabilidade e reinserir um indivíduo na sociedade (RIZZARDI et al., 2017). Desta forma, o cirurgião-dentista pode atuar como um agente de transformação social Com o objetivo de minimizar os desgastes dentários para recuperação de pequenos espaços protéticos, as fibras de reforço foram inseridas na prática dos clínicos (CAMPANHA et al., 2013). A utilização de fibra de vidro, proporcionou a idealização da prótese adesiva livre de metal constituindo-se, assim, uma opção estética e funcional para a ausência de dentes anteriores (CAMPANHA et al., 2013;FELIPE et al., 2015). ...
... Desta forma, o cirurgião-dentista pode atuar como um agente de transformação social Com o objetivo de minimizar os desgastes dentários para recuperação de pequenos espaços protéticos, as fibras de reforço foram inseridas na prática dos clínicos (CAMPANHA et al., 2013). A utilização de fibra de vidro, proporcionou a idealização da prótese adesiva livre de metal constituindo-se, assim, uma opção estética e funcional para a ausência de dentes anteriores (CAMPANHA et al., 2013;FELIPE et al., 2015). A prótese adesiva direta, Desta forma, o objetivo do presente trabalho é relatar um caso clínico de prótese adesiva direta com emprego de fibra de vidro associada com facetas em resina composta para recuperação de dois espaços edêntulos anteriores. ...
... Deste modo, a recuperação de dentes perdidos pode melhorar autoestima, autoconfiança, a sociabilidade e reinserir um indivíduo na sociedade (RIZZARDI et al., 2017). Desta forma, o cirurgião-dentista pode atuar como um agente de transformação social Com o objetivo de minimizar os desgastes dentários para recuperação de pequenos espaços protéticos, as fibras de reforço foram inseridas na prática dos clínicos (CAMPANHA et al., 2013). A utilização de fibra de vidro, proporcionou a idealização da prótese adesiva livre de metal constituindo-se, assim, uma opção estética e funcional para a ausência de dentes anteriores (CAMPANHA et al., 2013;FELIPE et al., 2015). ...
... Desta forma, o cirurgião-dentista pode atuar como um agente de transformação social Com o objetivo de minimizar os desgastes dentários para recuperação de pequenos espaços protéticos, as fibras de reforço foram inseridas na prática dos clínicos (CAMPANHA et al., 2013). A utilização de fibra de vidro, proporcionou a idealização da prótese adesiva livre de metal constituindo-se, assim, uma opção estética e funcional para a ausência de dentes anteriores (CAMPANHA et al., 2013;FELIPE et al., 2015). A prótese adesiva direta, Desta forma, o objetivo do presente trabalho é relatar um caso clínico de prótese adesiva direta com emprego de fibra de vidro associada com facetas em resina composta para recuperação de dois espaços edêntulos anteriores. ...
... Já a prótese fixa adesiva, é um componente das inúmeras formas reabilitadoras da prótese fixa. Baseia-se nos casos onde são apresentadas perdas dentárias que podem ser repostas através da confecção de preparos conservadores e a sua união aos dentes vizinhos por meio de cimentos especiais, resina composta, materiais de reforço e estruturas metálicas ou livres de metal (Campanha et al., 2013;Jorge et al., 2011). ...
A hospitalização de criança e adolescentes, em especial com doenças crônicas, gera momentos estressantes, decorrentes das diversas alterações no cotidiano, além de diversos procedimentos invasivos e dolorosos. Pesquisa exploratória e descritiva, de natureza qualitativa e comparativa. Foram analisados e comparados desenhos projetivos de duas Figuras Humanas, uma doente e a outra saudável, de três grupos estudados de crianças e de adolescentes. Participaram do estudo sete crianças no Grupo Saudável (GS), cinco crianças e adolescentes do Grupo Doente com Câncer (GDC) e três no Grupo Doente com Hemopatia (GDH). Um roteiro de avaliação dos aspectos de análise qualitativa da representação plástica em Arteterapia serviu de guia para analisar os desenhos, juntamente com o conhecimento teórico dos pressupostos de autores de desenhos projetivos, desenvolvimento gráfico e de dicionário dos símbolos. Os desenhos expressos pelos Grupos de crianças e de adolescentes Doentes com Câncer (GDC) e com Hemopatia (GDH) apresentaram atraso nos estágios de desenvolvimento, desenhos pobres e desvitalizados nesse momento de vida atual. Diferentemente dos participantes do Grupo Saudável que se mostrou com um desenvolvimento emocional mais equilibrado
... Já a prótese fixa adesiva, é um componente das inúmeras formas reabilitadoras da prótese fixa. Baseia-se nos casos onde são apresentadas perdas dentárias que podem ser repostas através da confecção de preparos conservadores e a sua união aos dentes vizinhos por meio de cimentos especiais, resina composta, materiais de reforço e estruturas metálicas ou livres de metal (Campanha et al., 2013;Jorge et al., 2011). ...
Embora as cerâmicas possuam alta resistência à compressão, apresentam friabilidade devido à sua baixa resistência à tração e, desta forma, possuem menor capacidade de absorver impactos. Este trabalho avaliou a tenacidade à fratura de diferentes sistemas cerâmicos, que refere-se à medida da habilidade de absorção da energia de deformação de um material friável. Foram confeccionados 30 corpos-de-prova em forma de discos (5mmx3mm) utilizando-se três diferentes materiais cerâmicos, os quais foram divididos em 3 grupos: G1-10 amostras confeccionadas com a cerâmica Vitadur Alpha (Vita-Zahnfabrik); G2-10 amostras confeccionadas com a cerâmica IPS Empress 2 (Ivoclar-Vivadent) e G3-10 amostras confeccionadas com a cerâmica In-Ceram Alumina (Vita-Zahnfabrik). Para a obtenção dos valores de tenacidade foi utilizada a técnica da indentação que se baseia na série de fissuras que se formam sob uma carga pesada. Foram realizadas 4 impressões por amostra, utilizado um microdurômetro (Digital Microhardness Tester FM) com uma carga de 500gf, durante 10 segundos. A análise estatística dos dados (Testes ANOVA de Kruskal-Wallis e Dunn), indica que a cerâmica In-Ceram Alumina apresentou valor mediano (2,96N/m3/2), estatisticamente diferente do apresentado pela IPS Empress 2 (1,05N/m3/2), enquanto que a cerâmica Vitadur Alpha apresentou valores intermediários (2,08N/m3/2), sem diferenças estatísticas dos outros dois materiais. Conclui-se que as cerâmicas apresentam diferentes desempenhos de tenacidade à fratura, sendo a In-Ceram capaz de absorver maior energia comparada a Vitadur Alpha e ao IPS Empress2.
All ceramic crowns are highly esthetic restorations and their popularity has risen with the demand for life-like and cosmetic dentistry. Recent ceramic research has concentrated on developing a fundamental understanding of ceramic damage modes as influenced by microstructure. Dental investigations have elucidated three damage modes for ceramic layers in the 0.5-2 mm thickness using point contacts that duplicate tooth cuspal radii; classic Hertzian cone cracking, yield (pseudo-plastic behavior), and flexural cracking. Constitutive equations based upon materials properties have been developed that predict the damage modes operational for a given ceramic and thickness. Ceramic thickness or thickness of the stiff supporting core in layer crowns is critical in flexural cracking as well as the flaw state of the inner aspect of the crown. The elastic module of the supporting structure and of the luting cement and its thickness play a role in flexural fracture. Clinical studies of ceramics extending over 16 years are compared to the above relationships and predictions. Recommendations for clinical practice are made based upon the above.
A clinical trial, concerning 203 resin-bonded bridges (RBBs), was performed for investigation of the influence of retainer-type and cementation materials on the survival of these restorations. The survival rates after a 7.5-year follow-up were 75% for anterior RBBs and 44% for posterior bridges. Etched metal RBBs (E-bridges) were significantly more retentive than perforated RBBs (P-bridges); the survival rates were 78% and 63%, respectively. With respect to the cementation materials, Clearfil F, in combination with E-bridges, had the best overall survival (89%, anterior and posterior). Maxillary anterior RBBs were more susceptible to failure than mandibular anterior RBBs.
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Inlay-retained resin-bonded fixed partial dentures (RBFPDs) are conservative
prosthetic restorations; however, their resistance to fracture is not clear.
The purpose of this study was to compare fracture loads of posterior complete coverage metalceramic restorations with all-ceramic inlay-retained RBFPDs.
In this regard; . Thirty-two posterior ceramic RBFPD restorations were divided into 4 groups (n=8): (1) Complete metal-ceramic fixed partial dentures (MC-FPDs) fabricated of Ni-Cr–based alloy (Wirolloy) and veneered with a ceramic (IPS d.SIGN) as the control group; (2) inlay-retained metal-ceramic (MC RBFPDs) with the same materials as the control; (3) inlay-retained lithium disilicate (LD) glass-ceramic (IPS Empress 2) RBFPDs; and (4) inlay-retained zirconia-based (Z) ceramic (Cercon) RBFPDs. Control specimens were prepared to receive conventional complete MC-FPDs designed to include a 1.3-mm-circumferential, 90-degree flat shoulder with rounded angles. Inlay-retained RBFPD specimens were prepared with 2-mm occlusal reduction but without bevels at the occlusal or gingival margins. Specimens were loaded and fracture loads (N) measured at fracture with a universal testing machine at a crosshead speed of 1.0 mm/min and 250 kgf load cell. Data were analyzed with 1-way ANOVA and Duncan test (a=.001).
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.
This study determined the load required to fracture a three-unit provisional fixed partial denture restoration, which had been reinforced with an experimental glass fiber reinforcement.
Provisional fixed partial dentures (n = 5) were fabricated from a resin of polyethyl methacrylate powder and n-butylmethacrylate liquid. The fixed partial dentures in the control group were unreinforced. In the other groups, the fixed partial dentures were reinforced either with one, two, or three unidirectional glass fiber reinforcements and one glass fiber weave reinforcement. The load was applied to the fixed partial dentures by a steel ball placed in the cavity in the middle fossa of the pontic tooth. A longitudinal section of the fixed partial denture was made to determine the position of the reinforcements. Means were compared by analysis of variance.
The load required to fracture the unreinforced fixed partial denture was 614 N, while incorporation of one unidirectional reinforcement increased the load to 660 N, two reinforcements to 818 N, three reinforcements to 827 N, and three reinforcements with one weave reinforcement to 973 N. It was found that the unidirectional reinforcements were positioned on the side of the occlusal surface of the fixed partial denture, namely, the side of compression during loading.
The results suggest that, even though the glass fiber reinforcements were positioned on the least favorable side of the fixed partial denture in terms of the physical properties of the materials, these reinforcements considerably increased the fracture resistance of the provisional fixed partial denture.
Recently, two alternatives to the etched metal, Maryland-type bridge have been proposed for anterior applications. These are the all-ceramic bridge and the composite resin framework, ceramic veneered pontic bridge. Both designs use acid-etched winged retainers for adhesion. The purpose of this study was to evaluate the load transfer to abutment teeth by these two designs using photoelastic modeling.
This case report describes the clinical and laboratory procedures for the fabrication and insertion of In-Ceram all-porcelain, resin-bonded bridges. All-porcelain crowns and fixed partial dentures have better biocompatibility and better esthetic results than do ceramometal restorations. In-Ceram has been shown to have better physical properties than other ceramic or glass materials. However, long-term clinical studies of the material are not yet available.
This report describes a technique for fabricating a splint or fixed partial prosthesis splint on mandibular anterior teeth without tooth reduction. The fixation is attained by applying a coupling agent to the gold and etching the enamel to enhance attachment with Sevriton. Clinical experience and judgment provide the final standard.
This report describes a clinical pilot study that monitored a group of 12 patients who have received 14 single tooth replacement experimental restorations made with prefabricated continuous fiber-reinforced composite (FRC) frameworks. Because these restorations represent a purely adhesive restorative system, tooth preparation was not performed. The Kaplan-Meier survival probability at 12 months was approximately 50%. The restoration with the longest service life was a mandibular molar replacement that has remained in service 24 months. With improved survival times, bonded FRC definitive restorations should be plausible.
The purpose of this in vitro study was to evaluate the influence of water storage and thermal cycling on the fracture strength of two designs of all-porcelain, resin-bonded fixed partial dentures made with the glass-infiltrated alumina ceramic In-Ceram. Forty frameworks of In-Ceram ceramic veneered with Vitadur-N porcelain were made to replace an upper central incisor bonded to extracted natural teeth. In 20 of the restorations the pontic was veneered only labially with Vitadur-N porcelain and no proximal box preparations were made (design A). The other 20 restorations had additional box preparations proximal to the pontic and the In-Ceram ceramic pontic framework was shifted to the labial aspect and veneered circumferentially with Vitadur-N porcelain (design B). Subgroups of 10 restorations were stored for 7 days in thymol solution or alternatively for 150 days in artificial saliva with thermal cycling for 18,750 cycles between 5 degrees and 55 degrees C. Restorations with design B had a statistically significantly higher fracture strength than restorations with design A. Storage in artificial saliva with thermal cycling significantly reduced the fracture strength of the resin-bonded In-Ceram fixed partial dentures. Therefore, the long-term clinical behavior of resin-bonded In-Ceram fixed partial dentures must be evaluated before general clinical use can be recommended.
Twenty all-porcelain In-Ceram bridges were resin bonded to natural teeth on a study model. Ten of the test specimens were fixed on abutments placed directly in resin, and 10 were supported by an artificial periodontal membrane. Incisal forces of physiological magnitude and direction were applied in three bridges of both groups (test samples) in an artificial oral environment (1250,000 cycles). The fracture strength of the six test and 14 control specimens was tested in a universal testing instrument and the rupture strength measured. There was no significant difference between the fracture strength of the test and control samples. The artificial periodontal membrane around the abutment teeth did not reduce the fracture strength of the In-Ceram bridges.
Resin-bonded fixed partial dentures (FPD) with a metal framework have some disadvantages: a grey shimmer of the metal wings through the abutment teeth, a higher corrosion rate, and an allergenic potential of the non-precious alloys used. The Al2O3 ceramic In-Ceram seems to be strong enough to serve as a framework for resinbonded all-ceramic FPDs. Because of the fact that ceramic wings often don't have enough inter-occlusal space, a new preparation design was developed. The objective of this study was to determine the influence of load orientation (45 degrees and 60 degrees) and the design of the interproximal connector on the stress distribution in the bridges. A 3-dimensional finite-element model was developed to simulate the anatomical situation. The biting force was assumed as 250 N and oriented in oro-buccal direction. The loading-point was palatal 1.5 mm beneath the incisal edge. It was found that stress generally increased with an angle of the biting force of 60 degrees. A small interdental connector (3 mm height) and/or strong interdental separation resulted in stresses of up to 455 MPa (45 degrees) or 534 MPa (60 degrees). Less separation with rounded edges and a higher connector (4 mm) reduced the stress to 122 MPa (45 degrees) and 143 MPa (60 degrees). Due to an average tensile strength of In-Ceram at 340-400 MPa, an all-ceramic resin-bonded FPD may only be recommended if the height of the connector could be minimum 4 mm. Rounded edges and little interdental separation are significant for stress reduction.
The success rate of resin-bonded fixed partial dentures is directly related to the adhesive system and the tooth preparation design for good retention.
This in vitro study evaluated the effect of various tooth preparation designs on the bond strength of retainers for adhesive fixed partial dentures.
Molar teeth were prepared in the conventional form or with occlusal coverage and opposing grooves and retainers were silicoated and bonded to etched enamel by a bis-glycerol methacrylate adhesive. Bond strengths were determined after water storage and thermocycling.
The least mean bond strength was recorded for the conventional form of tooth preparation (p < 0.05).
A combination of 180-degree opposing groove placement at line angles "wraparound" and occlusal coverage resulted in the greatest bonding values.
After 7 years of clinical experience, the alumina ceramic, In-Ceram, can be regarded as a well-proven material for all-ceramic crowns. Because of its high strength, this material can also be used for small all-ceramic fixed partial dentures. First attempts at using this material for resin-bonded prostheses revealed a high failure rate. The aim of this article is to present a new preparation design for all-ceramic resin-bonded fixed partial dentures that allows fabrication of highly esthetic and also tooth-saving adhesive prostheses. Clinical results over a period of 4 years revealed that they are strong enough to replace anterior teeth. Nevertheless, positive long-term clinical results are necessary before a general recommendation can be given for this kind of prosthesis.
The purpose of this clinical pilot study was to evaluate the resin bond to alumina ceramic in vivo when using a bonding method which had been shown to be successful in laboratory testing.
Seventeen resin-bonded all-ceramic bridges and splints fabricated from a glass-infiltrated alumina ceramic were tribochemically silica coated and resin bonded to their abutment teeth. The patients were recalled every 6 months to evaluate the restorations with regard to function and possible failures.
Over a mean observation time of 3.8 +/- 1.6 years some ceramic fractures occurred. However, the resin bond between the teeth and the alumina ceramic always remained stable.
Silica coating of alumina ceramic resulted in a durable resin bond over up to 5 years.
The aim of this study was to examine in-vitro whether adhesive fixed posterior inlay dentures (AFPID) made with the fibreglass-reinforced Vectris/Targis system (Ivoclar, Schaan, FL) have a fracture strength and a satisfactory marginal adaptation which can occur under clinical conditions. Extracted human third molars were embedded in a PMMA resin 10 mm apart to represent a molar gap. Two preparation methods were used: a box-shaped preparation technique (n = 8) and a tub-shaped preparation technique (n = 8). All AFPIDs were adhesively inserted using the dual curing composite cement, Variolink-high-viscosity (Vivadent, Schaan, FL). After thermocycling and mechanical loading (TCML: 6000 x 5 degrees C/55 degrees C, 1.2 Mio x 50 N, 1.66 Hz) in an artificial environment, the bridges were loaded to failure. Marginal adaption was investigated before and after TCML with the replica technique. After TCML, no significant difference was found in fracture strength between tub-shaped-preparation (median = 722 N, bending median = 0.9 mm) and box-shaped preparation (median = 696 N, bending median = 1.2 mm). A 'perfect margin' was observed in more than 60% of the investigated areas in both preparation techniques. With these values, the bridges can occur under clinical conditions and thus a clinical employment should be considered.
This is the first of two articles describing the development and use of a continuous fiber-reinforced composite as a framework for the fabrication of fixed partial dentures and splints. The chemical composition and physical structure of the fiber-reinforced composite, along with the progression and development of a variety of fiber-reinforced composite materials, are discussed. Criteria for case selection, tooth preparation, and the clinical and laboratory procedures required for partial- or complete-coverage fixed partial denture fabrication and delivery are described.
Restorative dentistry searches for nonmetal reinforcement of esthetic fixed partial dentures (FPDs).
This clinical study evaluated conservative fiber-reinforced composite FPDs bonded to inlay abutments.
Twenty fiber-reinforced composite inlay FPDs were made for 15 patients. Restorations were manufactured with the Targis Vectris glass-fiber-reinforced composite system and a simplified laboratory technique. The 20 bonded inlay FPDs were examined clinically and by SEM after 1 year.
All 20 FPDs were intact at the 1-year examination. There were no signs of fracture, surface defects, or excessive wear with SEM. SEM marginal analysis exhibited 91.6% +/- 5% excellent margins at the tooth-luting composite interface and 86. 1% +/- 8% excellent margins at luting composite/restoration interface.
On the basis of the results of this descriptive study, bonded glass-fiber-reinforced composite inlay FPDs were considered clinically successful at the 1-year examination.
In the 25 years since the first resin-bonded prosthesis was described, this adhesive technique for splinting mobile teeth has developed into a conservative method for replacing missing teeth. There was a high debond rate associated with the early resin-bonded prostheses, which led many clinicians to question their clinical appropriateness for long-term use. These early failures were attributed to the limited bond strength between the metalwork and etched enamel. Despite improvements in the adhesive bond strengths, there was still an unacceptable number of clinical debonds. The biomechanical design of resin-bonded prostheses did not develop with the same rapidity or with the same predictability as did the advancements with the associated adhesive technology. Through ongoing development, studies have shown various biomechanical designs that may improve clinical retention. The purpose of this article is to examine the biomechanical principles for current resin-bonded prosthesis design, including aspects of tooth preparation and framework design that will improve clinical retention.
The present case report describes a 1-year follow-up of functional rehabilitation of a young periodontal patient with severely advanced, rapidly progressing marginal bone loss treated by using a new splinting material, i.e., glass fiber-reinforced composite (FRC). Apart from one single tooth, the young man had retained all his natural teeth.
Periodontal treatment was based on cleaning and root planing enabled by partial-thickness-flap operations. This method was selected to avoid further damage to the remaining alveolar bone. After healing for 6 months, a cavity retained internal FRC splint was constructed and 1 missing lower molar was replaced by an inlay-retained FRC resin-bonded fixed partial denture (FPD). A 12 months follow-up period revealed a healthy periodontium and good functional and esthetic results.
The new material allows the use of periodontal treatment methods instead of prosthetic alternatives, which until now have been a more generally used approach in the treatment of severely advanced periodontal cases. Internal fiber-reinforced composite splinting being affordable for the patient, easy for the clinician to construct and giving good esthetic and functional results, suggests that the method may be a valuable aid in periodontal treatment.
There are no studies that analyze the long-term durability of minimally invasive fixed partial dentures (FPDs) by comparing different methods of adhesive bonding.
This in vitro study examined the influence of cavity design and operative technique on the marginal adaptation of resin-bonded composite FPDs.
Slot-inlay tooth preparations with cavity margins located in enamel were prepared in 18 maxillary canines and 18 maxillary first molars designated as abutments. The specimens were divided equally into 3 experimental groups. In all groups, butt joint tooth preparations were created in canines and molars. In group 2, canines were prepared additionally with a 1.5-mm wide palatal bevel in enamel. After pretests with modification spaces of 11 and 17 mm (length), 2 missing premolars were replaced by the ceromer Targis and reinforced with the glass-fiber material Vectris. The prostheses were inserted with Tetric Ceram with use of an ultrasonic-supported, high-viscosity technique. Restorations were selectively bonded to cavity finish lines in groups 1 and 2 ("selective bonding"). In group 3, restorations were bonded totally to the whole cavity surface ("total bonding"). The restorations were stressed in a computer-controlled masticator. Marginal quality was examined with an SEM at x 200.
The percent area of optimal margins after thermomechanical loading between composite and enamel in each group was as follows: group 1, 86.2% +/- 12.3% for canines and 95.5% +/- 3.5% for molars; group 2, 95.3% +/- 2.1% for canines and 96.2% +/- 2.7% for molars; and group 3, 95% +/- 0.9% for canines and 86.4% +/- 3.2% for molars. The marginal quality for molars inserted with total bonding was significantly lower (P< or =.05).
Within the limitations of this study, the selective bonding technique for slot inlay-retained fixed partial dentures resulted in a negligible loss of marginal quality after extensive mechanical and thermal stress. The selective bonding technique is recommended for box-shaped cavity preparations.
To clinically evaluate conservative fiber-reinforced composite inlay fixed partial dentures (IFPDs) bonded to inlay abutments.
Forty fiber-reinforced composite IFPDs were made for 29 patients. Restorations were manufactured with the composite Targis reinforced by Vectris prefabricated glass-fiber elements and were inserted with a high viscosity insertion technique. Forty bonded IFPDs were examined clinically after 1 year, and 25 after 2 years, using modified USPHS criteria. Twenty-five abutment inlays and 12 pontics were analyzed quantitatively by scanning electron microscopy SEM. Results were tested for statistical significance with ANOVA.
Although most clinical criteria were rated "alpha", four IFPDs had to be replaced: two retainers debonded and two presented total delamination of veneering material from fiber framework. Two partial delaminations were repaired intraorally. No fractures of framework were observed. SEM marginal analysis of tooth-composite interface exhibited 96.5 +/- 3.0% continuous margin at baseline, 91.0 +/- 5.7% at the 1-year and 89.6 +/- 5.2% at the 2-year recall. Decrease of marginal quality was statistically significant between baseline and 1 year (P= 0.001), but not between 1- and 2-year recalls.
This clinical report describes the use of intraoral silica coating and silanization in an alternative bonding procedure for a 3-unit, all-ceramic, resin-bonded fixed partial denture.
Inlay-retained resin-bonded fixed partial dentures (RBFPDs) are conservative prosthetic restorations; however, their resistance to fracture is not clear.
The purpose of this study was to compare fracture loads of posterior complete coverage metal-ceramic restorations with all-ceramic inlay-retained RBFPDs.
Thirty-two posterior ceramic RBFPD restorations were divided into 4 groups (n=8): (1) Complete metal-ceramic fixed partial dentures (MC-FPDs) fabricated of Ni-Cr-based alloy (Wirolloy) and veneered with a ceramic (IPS d.SIGN) as the control group; (2) inlay-retained metal-ceramic (MC RBFPDs) with the same materials as the control; (3) inlay-retained lithium disilicate (LD) glass-ceramic (IPS Empress 2) RBFPDs; and (4) inlay-retained zirconia-based (Z) ceramic (Cercon) RBFPDs. Control specimens were prepared to receive conventional complete MC-FPDs designed to include a 1.3-mm-circumferential, 90-degree flat shoulder with rounded angles. Inlay-retained RBFPD specimens were prepared with 2-mm occlusal reduction but without bevels at the occlusal or gingival margins. Specimens were loaded and fracture loads (N) measured at fracture with a universal testing machine at a crosshead speed of 1.0 mm/min and 250 kgf load cell. Data were analyzed with 1-way ANOVA and Duncan test (alpha=.001).
Fracture loads (mean +/- SD) were greatest for control specimens (1318.43 +/- 211.00 N) and Z-RBFPD (1247.70 +/- 262.51 N) specimens as compared to MC-RBFPD or LD-RBFPD (P < .001). MC-RBFPD exhibited the next highest fracture loads (958.01 +/- 194.29 N), and LD-RBFPD exhibited the significantly lowest values (303.23 +/- 92.54 N) of the materials tested (P < .001).
Inlay-retained zirconia-based ceramic RBFPDs demonstrated the greatest fracture resistance among all inlay-retained restorations tested.
Fifty-three posterior glass fibre-reinforced composite inlay-fixed partial dentures (IFPDs) in 36 patients were followed for 5 yr. For statistical analysis, one IFPD per patient was randomly selected. The survival rate and influence of discrete predictors (gender, location) and continuous variables (age, abutment surfaces) were determined. Clinical observations were recorded by using modified United States Public Health System (USPHS) criteria. Replicas of 17 randomly selected abutments were analysed by scanning electron microscopy (SEM) for marginal adaptation and the results were compared by using a repeated-measures analysis of variance (anova). The main reason for failure was veneering material delamination from the framework. The cumulative survival rate after 5 yr was 73% (95% confidence interval: 57-89%) for not delaminating and 96% (95% confidence interval: 88-100%) for not debonding. No significant influence of the tested predictors was found. Significant changes between baseline USPHS criteria and counterparts recorded at recall were fractures of the veneering material (chipping), wear, surface texture, and staining. Significant margin changes were only found between baseline and 1 yr. Thereafter, marginal adaptation remained stable. After 5 yr, 90% of the margins were termed as perfect. It was concluded that hard-tissue saving IFPDs with the current design maintained acceptable retention and marginal integrity. Future studies should aim at reducing delaminations by searching for improved framework designs and materials.
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