INTRODUCTION:

Unquestionably one of the disadvantages of a conventional fixed

partial denture with either full veneer or partial veneer crown retainers is the
destruction of tooth structure required for the abutment preparations upon
which the retainers will be placed. Most frequently the patient may ask, “is
it really necessary to cut away all that good tooth ?” This question has
troubled dentists in prescribing the replacement of missing tooth, as they
have tried to balance the periodontal, occlusal, and esthetic benefits of
prosthesis against the damage to the abutment teeth.
Various solutions for this problem have been tried through the year
like inlay retainers, cantilever fixed partial denture, unilateral removable
partial denture.
The development of acid etching of enamel to improve the retention
of resin, first described by Buonocore in 1955, has proven to be a means of
attaching fixed partial dentures to teeth by less destructive means.
 Ibsen first described the attachment of an acrylic resin pontic to an
uprepared tooth using a composite bonding resin.
 Resin retained fixed prosthesis consists of one or more pontics
supported by a thin metal retainers placed lingually and proximally on
the abutment teeth. Contrasted with conventional fixed prosthesis,
which depends on geometric shape of a circumferential tooth
preparation, these prosthesis rely in part on adhesive bonding between
etched enamel and the metal casting. They are held in place by resin,
which locks mechanically into chemically etched enamel and in to
microscopic undercuts in the casting.
DEFINITION : (According to GPT 7) :
A prosthesis that is luted to tooth structures, primary enamel, which
has been etched to provide mechanical retention for the resin cement.
HISTORY :
The use of an acrylic resin denture tooth as a pontic was first
published in 1973. In addition Ibsen and Buonocore have also described the
use of the extracted tooth as a pontic. Buonocore described cutting a mesio-
distal retentive groove in the lingual surface of an acrylic denture tooth and
then roughening all the bonding surfaces of the pontic prior to treating these
surfaces with methyl methacrylate.
In 1978, Jordan describe a technique in which he used
autopolymerizing resins instead of ultraviolet light curing materials, and
class III preparations were cut in to pontic crowns, rather than lingual
retentive groove.
Successful composite resin pontic fixed partial dentures were
created that have been functional for more than five years. The
technique consists of making the pontic by injecting composite resin of
described shade into a clear plastic crown form. The pontic is then
adapted to the ridge ( on a plaster model or in the patient’s mouth) and a
glaze layer of unfilled resin is applied to the pontic where it will contact the
ridge. Care must be taken when handling the pontic so as not to contaminate
the surfaces to be bonded, so finger cots can be used. Simonsen, Davila
and Gwinnett have also described use of the natural tooth as a pontic. The
technique is to cut off the root, seal the root canal, and bond the clinical
crown back in to space from which it was extracted. Lambert and co-
workers used acrylic resin pontics and suggested that the application of
this technique to the clinical practice of dentistry is warranted. Sweeney
and co-workers tested similar single unit pontic attachments against
those where a wire was incorporated with in the composite resin for
increasing the strength; surprisingly the test conditions used found
that the wire incorporated actually decreased the strength and the
conclusion of these investigations is that the greater bulk of the composite
resin in perhaps the key to success.
In 1973 Rochette described the use of perforated retainer. Now, with
the advent of electrolytic etching of alloy and significant improvement in
bond strength ,Rochette retainer is rarely used.
Proper enamel modification is needed to ensure that the framework
has only one path of insertion, resists all displacement forces, except those
along the path of insertion, and directs any loading parallel to the long axis
of the abutments. Correct framework design utilizes a large area for bonding
and engages the proximal surface for sufficient resistance form, and it
provides for optimum esthetics by minimizing visibility of the metal frame
work.
REQUIREMENTS :
Three principles are fundamental to achieve predictable results:
Proper patient selection, correct enamel modification, and framework
design.
CLASSIFICATION :
According to William. A .et al : (Quint of dental technology 1987; 11,
253-258:)
I)DIRECT TECHNIQUES :
Chairside designs may be classified according to the type of pontic
employed in the design.
A) An acrylic denture tooth is used as a pontic.
B) A composite resin tooth is used as a pontic.
C) An avulsed tooth is used as a pontic.
D) A self curing acrylic (e.g. methyl or ethyl-methacrylate) tooth is used
as a pontic.
These pontics may be used in conjunction with wire or wire-mesh
strengtheners for increased retention.
II) INDIRECT TECHNIQUES :
TYPE 1 : CAST METAL FRAMEWORK :
Class 1 : Perforated framework eg. Rochette bridge.
Class 2 : Electrolytically etched surface framework. Eg. Maryland bridge.
Class 3 : Void-containing surface frame work. Eg. Sand-abraded surfaces,
Moon and knap bridge, and the CFB bridge (cedia)
Class 4 : Mesh-surface frame work. Eg. Duralingual bonded bridge (unitek)
and the Klett-O-Bond bridge (Renfert).
TYPE 2 : ACRYLIC FRAMEWORK
Class 1 : Perforated framework (FABB design)
ADVANTAGES :
1) REDUCED COST : This is probably not as significant as was first
thought when little or no preparation was involved with the technique.
However, with the increased use of preparation features, more of the
dentist’s time and skills are required, and the cost differential between a
conventional prosthesis and a resin-bonded fixed partial denture has
become less.
2) NO ANAESTHETIC NEEDED : An anesthesia is not required because
most of the preparation will be done in enamel.
3) SUPRAGINGIVAL MARGINS : Although supragingival margins can
be used with conventional retainers also but they are mandatory for the
resin-bonded fixed partial dentures.
According to WilliamV.D.etal:JPD 1989; 61,436: It was shown that
after 10 years of clinical trial, only 7% of restorations were associated
with crevicular depth more than 3mm.
4) MINIMAL TOOTH PREPARATION : Little tooth structure has to be
removed for this technique, making it more conservative and less likely
to create problems in unblemished abutment teeth. .
5) REBONDING POSSIBLE : Resin-bonded fixed partial dentures can be
rebonded if the “Wings” or axial extensions are not sprung or bent when
the restoration debonds. Removal of resin-bonded bridges in cases of
debonding by use of specially designed ultrasonic scaler tips has been
described.
Removal of acid-etched FPD with ultrasonic scaler tips : JADA 1986;
112: 505-507 :
Eighteen maxillary central incisors were prepared. The teeth were
separated in to three groups of six teeth each. The teeth in group 1 were
tested at gingival margins only; teeth in group 2 were tested at incisal
margins only; and the teeth in group 3 were tested both at gingival and
incisal margins.
With in each group the ultrasonic scaler was set at low power for
three teeth and at high power for other three teeth. Two types of tips were
used. One was straight chiesel design and the other tip was of a curved
chiesel design.
They concluded that by a combination of two ultrasonic tips at
various locations at the composite-
retainer interface required less than 5 min for removal and the retainer
surfaces for both high and low power settings did not disclose any
differences.
6) IMPRESSION MAKING : It is simplified due to supragingival
margins.
7) PROVISIONAL RESTORATION : As the abutment teeth are
maintained with normal proximal contacts in addition to being non
sensitive, a removable appliance may suffice as a provisional restoration.
8) CHAIR SIDE TIME : It is reduced as compared to conventional fixed
prosthodontics.
DISADVANTAGES :
1) UNCERTAIN LONGEVITY : There is still some concern about the
longevity of this type of prosthesis
According to Marinello. et al, J Oral Rehabil: 1987; 14:251-260 :
Success rate dropped from 95% after 3 months to 91% at 6 months,
81.5% at 1 year, and 73% at 18 months.
According to Shaw MJ, Tay WM: Br Dent J 1982; 152, 378-380 :
A total of 46 Rochette bridges were fitted in 42 patients. The mean
period of functional service was 20 months (range 2 to 44 months). 45
bridges continue to function satisfactorily although 8 of them required re-
attaching at some stage. One bridge was replaced by a conventional bridge.
According to Hudgins JL, Moon PC, Knap FJ : JPD 1985; 53: 471-476 :
The study was done to adapt the particle-roughened pattern technique
to an indirect model system by sandblasting it for a total of 2-3 seconds with
a micropencil and 60 m alumina particles and then measure the force
required to separate the retainer from the tooth. They concluded that the
particle roughened metal retainer possesses sufficient mechanical bond
strength for resin-bonded systems.
According to Priest GF, Donatelli HA : JPD 1988; 59:542-546 :
They did a four-year clinical evaluation of resin-bonded fixed partial
dentures in which most retainers were electrolytically or chemically etched.
A total of 58 resin-bonded fixed partial dentures seated in 47 patients
were examined for period of 2 to 51 months. During this evaluation period,
10 prosthesis (17.2%) became dislodged. Six restorations (10.3%) were
successfully rebonded and four (6.9%) were remade. Six anterior and four
posterior restorations were dislodged. Six mandibular and four maxillary
prosthesis become debonded. One restoration containing more than one
pontic was dislodged. They concluded that :
 1) Resin-bonded fixed partial dentures are indicated as definitive
prosthesis.
2) Chemically etched prosthesis offer better retention than
electrolytically etched or perforated prosthesis.
3) Prosthesis location does not appear to affect retention.
4) Differences seem to exist in retentive strengths of cementing agents.
According to Cruegers NHJ, et al : J oral rehabil 1989; 16,521-527 :
Clinical performance of resin-bonded bridges was checked for 5
years. A total of 203 resin-bonded bridges was inserted under controlled
clinical conditions and evaluated for a number of patient-dependent
variables over a period of 5 years. Of the variables evaluated only ‘initial
occlusion of the abutment teeth’ and ‘location in dental arch’ had a
significant influence on retention of resin-bonded bridges.
 Anterior resin-bonded bridges were more durable than the posterior
bridges.
 Mandibular posterior brides showed lowest retention rate.
It was concluded that the design of posterior resin-bonded bridges
should include tooth preparation or a wrap around design of the retainers.
2) NO SPACE CORRECTION : Although some porcelain can be added
to the metal retainer on the adjacent abutment teeth, there are definite
limitations on what can be done if the edentulous space is significantly
wider than the mesiodistal width of the tooth that would normally
occupy the space.
3) NO ALIGNMENT CORRECTION : It is impossible to correct
alignment problems with this restoration, in as much as nothing is done
to facial, proximal, and incisal areas of the abutment teeth.
4) LIMITED PATIENTS : There is limited number of patients in which
this technique can be used. Clinical indications and contraindications are
 quite specific.In presence of any contraindication, a conventional FPD
should be used to minimize the potential for failure.
5) EQUIPMENT REQUIREMENTS : Additional equipment required for
dental laboratory or dental office.

INDICATIONS :
1) CARIES FREE ABUTMENT TEETH : If the edentulous span is not
too long, the resin-bonded fixed partial denture allows tooth replacement
with minimal destruction of tooth structure on undamaged abutment
teeth.
2) MANDIBULAR INCISOR REPLACEMENTS : The acid-etched
resin-bonded fixed partial denture is the restoration of choice for
replacing one or two missing mandibular incisors when the abutment
teeth are unblemished.
3) MAXILLARY INCISOR REPLACEMENT : Maxillary incisors can
be replaced if they are in an open-bite, end-to-end, or moderate overbite
situation.
4) PERIODONTAL SPLINTS : If a resin-bonded prosthesis is to be used
as a splint, careful attention must be paid to resistance features on the
abutment preparation. The splinting of periodontally involved teeth
comprised the first published report of the use of a resin-bonded
prosthesis by Rochette.
According to Rochette AL: JPD 1973; 30, 418-423:
He described a technique for fabricating 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. Splints and fixed partial
prosthesis splints made by this technique have been in service for 24 months
without failure.
According to Marinello. et al: J oral Rehabil 1988, 15: 223-235 :
1) They indicated that the failure rate for splints was 13% greater than that
for fixed partial dentures.
2) Use of grooves on abutments for splints improved the chances for
success by nearly 15%.
5) SINGLE TOOTH REPLACEMENTS : While replacement of multiple
teeth can be done with this type of prosthesis, it becomes a higher-risk
procedure. Resin-bonded fixed partial dentures of more than three units
have a 10% higher failure rate than those that are only three units in
length.
Resin bonded FPDs of greater than three unit length should be used only
if there is some mitigating treatment – planning consideration, such as
opposing a removable partial denture, which would result in less occlusal
stress.
According to Chang H.K. et al: JPD 1991; 65, 778-781 :
49 resin-bonded FPD’s were evaluated in the clinic, 43 were acid-
etched metal, resin-bonded FPD’s, four were combinations of resin-bonded
and conventional FPD’s, and two were composite resin pontics.
1) The average length of service for the 43 FPDs was 47.3 months.
2) Fixed partial dentures with more than two retainers have a failure rate
2.5 times that of resin-bonded FPDs with only two retainers.
6) IN CHILDREN : For many years resin retained restorations were
confined to the replacement of missing anterior teeth in children.
Conventional fixed prosthodontic techniques are generally
contraindicated in young patients because of management problems,
inadequate plaque control, the large size of pulps, and the patient’s
participation in sports. Presently resin-retained FPDs are used in patients
of all ages. Generally only one or two teeth with mesial and distal
abutment should be replaced with resin-retained FPD.
CONTRAINDICATIONS :
1) EXTENSIVE CARIES : Because the resin-bonded FPD covers
relatively little surface area and relies on bonding to enamel for its
retention, the presence of caries of any size will require the use of a more
conventional prosthesis.
2) NICKEL SENSITIVITY : Since most resin-bonded fixed partial
dentures are etched nickel-chromium restorations, nickel sensitivity in a
patient requires that another alloy to be used or that another type of
prosthesis be employed.
3) DEEP OVERBITE : So much enamel must be removed from the
lingual surface of a maxillary incisor in this occlusal relationship that
retention would be drastically reduced because of poor bonding strength
afforded by exposed dentin.
4) ABONORMAL OCCLUSAL FORCES : Resin-retained FPDs should
not be used where above average lateral forces are likely to be applied
e.g. In a patient with parafunctional habits or in a patient who requires an
anterior tooth replacement in presence of an unstable or nonexistent
posterior occlusion.
5) CROWN LENGTH : The connector area must be properly designed to
permit access for plaque control. If embrassure spaces are filled by the
prosthesis to the extent that plaque control is impeded, periodontal
complications are likely to occur. Thus, short clinical crowns and narrow
embrassures are contraindicated.
6) CROWN SURFACE AREA : Retention is dependent on having an
adequate surface area of enamel. If surface area is less, surgical crown
lengthening is necessary to increase the bondable surface area and
because subgingival margins should be avoided.
7) QUALITY OF ENAMEL : Any defects, such as hypoplasia or
demineralization, or congenital problems, such as amelogenesis
 imperfecta or dentinogenesis imperfecta, will adversely affect resin bond
strength. Finally, there are difficulties with technique that can be
especially apparent on thin abutment teeth. The labiolingual thickness
and translucency of enamel should be assessed to determine the potential
for darkening of the abutment teeth due to showing through of metal
retainer.
FABRICATION :
In the fabrication of resin-retained FPDs, attention to detail in all
three phases is necessary for predictable success :
1) Preparation of the abutment teeth.
2) Design of the restoration, and
3) Bonding.
TOOTH PREPARATION :
The earlier use of acid-etched resin-bonded FPD’s was accomplished
with no preparation of abutment teeth, emphasizing its reversibility, but
preparation features are used by many to enhance the resistance of resin-
bonded FPD’s. The tooth preparation includes axial reduction and guide
planes on the proximal surfaces with a slight extension onto the facial
surface to achieve a faciolingual lock.
The preparation should encompass at least 180 degrees of the tooth
to enhance the resistance of retainer.
According to Burgess J.O: JPD 1989; 61, 433-436 :
Electrolytically etched castings with grooves, half grooves, pins, a
labial wrap, and no additional resistance feature (lingual plate only) were
cemented to properly etched enamel. All specimens were loaded in tension
from lingual surface with an Instron testing machine at a crosshead speed of
0.05 in / min.
Specimens with proximal extensions (3/4 crowns, full grooves or
labial wrap) required significantly more load for displacement than the other
groups. This study demonstrated that the need for proximal extensions when
designing retainers for the Maryland Bridges.
According to Simon J.F. et al : JPD 1992; 68, 611-615:
Retentive grooves were placed at line angles to create mechanical
lock for the resin-bonded FPD. The 4-year retention of posterior resin-
bonded FPD improved from 60% to 95% by the placement of proximal
grooves. The study was conducted in a dental school clinic during a period
of 10 to 52 months.
The preparation must be extended as for as possible to provide
maximum bonding area. Thee should be a finish line even though it will be
nothing more than a very light chamfer, and it should be placed about
1.0mm supragingivally. Occlusal clearance is needed on very few teeth that
are prepared as abutments for acid-ached resin-bonded FPDs. Specifically
0.5mm is needed on incisors when preparation is done on the lingual
surfaces of the teeth. Because of the limited thickness of enamel near
cementoenamel junction, this type of restoration cannot be used on patients
with a severe class II vertical overlap.
Vertical stops are placed on all the preparations.This will consist of
two or three flat countersinks on the lingual surface of an incisor, a
cingulum rest on a canine or an occlusal rest seat on a premolar or molar.
The occlusal rest directs the applied force from the pontic to the abutments.
The minimum thickness for the connector of an etched metal bridge is same
as that for the connector used in the same position in a unit cast
conventional bridge made from same alloy.
According to Barrack.G : JPD 1987; 57, 133-138 :
Two occlusal rests are recommended for increased rigidity. If there is
an existing amalgam restoration, all of the amalgam, or at least all of its
surface, is removed so that the box form can be utilized.If the retainer
margins cross over an amalgam-enamel margin, there is high probability of
leakage occurring around that margin.

According to Humbree J.H. et al : Quinteesence Int 1986; 17, 479-482 :

Placing rest seats of an acid-etched composite resin bonded casting
framework on natural tooth structure produced minimal or no leakage.
Placing the rest seat on a composite resin restoration produced minimal or
no leakage. Preparing the rest seat margin in amalgam produced moderate to
gross leakage, with the leakage pattern beginning at the interface of the
cementing resin and the amalgam. When an amalgam restoration exists in
the tooth, it is advantageous to cover the restoration with the rest seat to
minimize leakage patterns.
The preparations used on different teeth include those made for a
maxillary or mandibular incisor, a canine, maxillary premolars and a
mandibular second premolar, all of which have a proximal groove near the
facio- proximal line angle adjacent to the edentulous space. There is second
groove on opposite side of the cingulum or lingual cusp of the tooth, which
creates a wraparound effect in the retainer and produces resistance in the
process. Both grooves should be placed in enamel. The preparation for a
mandibular first premolar is slightly different from that for other premolar
preparations. Because the placement of a rest seat would leave very little
solid tooth structure in the small lingual cusp of many first premolars,
coverage of entire small lingual cusp is substituted which should not
interfere with occlusion and is an excellent means of increasing surface area
and reinforcing the retainer.
The last preparation to be considered is that for the molar. Its
preparation in either maxillary or mandibular arch is very similar to the
preparation used on a premolar. The framework can be bolstered by capping
the lingual cusps as described for premolars, which produces rigidity.
Occlusal inlays can be attached to anatomic grooves, such as lingual or
distolingual grooves. Axial coverage can be extended through the proximal
contact to connect with occlusal rests or inlays. Any extension of an
occlusal groove can be used to good advantage in preventing the flexing of
the ends of axial coverage, or a “wing”.
ANTERIOR PREPARATION :
PREPARATION ARMAMENTARIUM :
1) High-speed hand piece
2) Articulating ribbon
3) Small wheel and short needle diamonds
4) Flat-end and round-end tapered diamonds.
PREPARATION SEQUENCE :
The preparation sequence discussed is for a maxillary incisor.
First, the centric occlusal contacts are marked with articulating
ribbon. To insure adequate occlusal clearance in this area, use a small wheel
diamond to remove 0.5 mm of tooth structure. This particular step is
necessary only on maxillary anterior teeth. Use the same small wheel
diamond to create a concave reduction on the entire cingulum surface of
incisor, producing 0.5mm of lingual clearance. End this reduction 1.5 to 2.0
mm from incisal edge, or just incisal to the incisal most occlusal contact,
whichever is closer to the incisal edge. Use a flat end tapered diamond to
prepare flat notches or countersinks on the lingual surface of the tooth to
provide resistance to gingival displacement.
Proximal reduction on the surface adjacent to the edentulous space is
done with a round–end tapered diamond, producing a small plane that
extends slightly facial to the facio-proximal line angle. This helps produce
facial wraparound to enhance resistance, a feature that will be less
prominent on maxillary anterior teeth than on mandibular teeth. A second
plane is produced lingual to the first with the same diamond.
 Light upright lingual axial reduction is done from the biplanar
proximal axial reduction around the cingulum to a point just short of the
proximal contact on the opposite side of the cingulum from the edentulous
space. The thickness of the axial walls of the retainer will be greater than the
amount of axial tooth structure removed, leading to overcontouring of the
axial walls of the cast retainer. To minimize any deleterious effect on the
periodontium, the very light chamfer finish line should remain
approximately 1.0 mm supragingival throughout its length.
A short groove is placed at the facialmost extension of the reduction
on the opposite side of the cingulum using a short needle diamond. In
addition to bolstering the rigidity of the retainer, the groove will serve to
enhance its resistance. Use the same thin diamond to place a groove in the
vicinity of the wraparound or break between the facial and lingual planes of
proximal axial reduction adjacent to edentulous space.
POSTERIOR TOOTH PREPARATION :
The basic framework for the posterior resin-retained FPD consists of
three major components. The occlusal rest (for resistance to gingival
displacement), the retentive surface (for resistance to occlusal
displacement), and the proximal wrap (for resistance to tonguing forces).
A spoon-shaped occlusal rest seat, similar to removable partial
denture is placed in the proximal marginal ridge area of the abutments
adjacent to the edentulous space. An additional rest seat may be placed on
the opposite side of the tooth. To resist occlusal displacement the restoration
is designed to maximize the bonding area without unnecessarily
compromising periodontal health or esthetics.Proximal and lingual axial
walls are reduced to lower their height of contour to approximately 1mm
from the crest of free gingiva. The proximal walls are prepared so that
parallelism results without undercuts. The bonding area can be increased
through extension on to the occlusal surface provided it does not interfere
with the occlusal generally, a knife-edge type of margin is recommended.
Resistance to lingual displacement is more easily managed in the
posterior region of the mouth. A single path of insertion should exist. The
alloy framework should be designed to engage at least 180 degrees of tooth
structure when viewed from the occlusal. This proximal wrap allows the
restoration to resist lateral loading by engaging the underlying tooth
structure. It should not be possible to remove a properly designed resin-
bonded FPD in any direction but parallel to its path of insertion.
In general, the preparation differs between maxillary and mandibular
molar teeth on the lingual surfaces only. The lingual wall of mandibular
tooth may be prepared in a single plane, and the lingual surfaces of the
maxillary molars dictates a two plane reduction due to taper of these centric
cusps in the occlusal two thirds and occlusal function.
According to Eshleman.J.R., et al : JPD 1988, 60,18-22 :
The lingual surface of maxillary molar tapers buccally in the occlusal
two thirds of the teeth and the outer incline of the lingual cusp is usually in
occlusion. Therefore, the lingual surface should be prepared in two planes.
First, the cervical plane is prepared parallel to the long axis of the tooth and
confluent with the proximal slice. Before preparation of second plane, the
centric contacts are marked with articulating paper. This plane is then
prepared tangent to the external surface of the occlusal two thirds of the
lingual surface and terminated in a beveled or light chamfer finish line just
apical to the marked centric contacts. The same principles apply for
maxillary premolars except that they usually have less convergent lingual
surfaces.
Occasionally a combination prosthesis can be used. This type of FPD
includes a resin- bonded retainer on one of the abutment teeth and
conventional restoration on the other.
FRAMEWORK FABRICATION :
Framework design for resin-bonded FPD is important. There must be
an adequate thickness of metal in the finished restoration so that it will be
immune to distortion and/ or dislodgement.

According to Caputo A.A. et al : Quintessence lnt 1986; 17,89-93 :

They found through the use of photoelastic stress analysis that
stresses could be lowered significantly by thickening the wraparound arms
of the retainer to 0.6mm and including proximal extensions.
Failure to reduce stress in the arms of the retainer will be translated
into fatigue failure of the underlying resin bonding material.
DUPLICATION ARMAMENTARIUM :
1) Full- arch master stone cast
2) Flat –surface metal sprue former block-out pin
3) PKT No. 1 waxing instrument, sticky wax, Bunsen burner.
4) Duplicating flask, modelling clay, duplicating hydrocolloid.
5) 500-cc Vac-U-Mixer, vacuum tubing.
6) Vibrator
7) Water measure, spatula, brush, investment
8) Conical metal sprue former.
MASTER CAST DUPLICATION :
The framework pattern is finished on a refractory cast, which is made
by duplicating the full-arch master stone cast made from the first pour of the
impression. The cast that is duplicated should be complete with a smooth
center. ‘Horse shoe’ casts, or those with uneven, rough areas in the lingual
space, are not acceptable. To avoid undercuts, the periphery of the cast is
trimmed so that its sides are perpendicular to the base. If it is trimmed so
that is slants in toward the base, the resultant severe undercut will interfere
with removal of cast from the duplicating material. An extra step of “
blocking out” will be required.
Fill in voids and any deep tissue undercuts in the vestibular area with
modelling clay. Lute a flat-surface metal sprue former block-out pin in
place. Soak the cast by placing the base in water for approximately 30
minutes. Immersing the entire cast may erode the surface of the cast in the
area of abutment preparations, whose accurate reproduction is essential.
Set the cast on the base of duplicating flask and hold it in place with a
small piece of modelling clay on either side of the cast. Fill in any undercuts
around the periphery of the base. Place a thin strip of modeling clay around
the periphery of the flask base so that it will from a seal when the flask is
seated on the base. Position the top of the flask over the base and fill it with
duplicating hydrocolloid. Place the flask in circulating water bath and allow
it to cool for 45 minutes.
After the duplicating material has set, remove the base from the
bottom of the flask and separate the cast from the hydrocolloid. Mix
investment and place the conical metal sprue former in to the conical
depression created in the palatal area of the mould by the block-out pin. Pour
the investment into the mould and allow it to set for 60 minutes.
After 1 hour, break away the duplicating material and remove the
sprue former from the center of the cast. Trim the refractory cast on a model
trimmer. Place it in drying over for 1 hour at 82 to 93 0C (180 to 2000F). Put
the refractory cast in the metal basket of a deep fryer, and immerse it in
beeswax that has been preheated to 1490C (3000F). When the wax bubbles,
time it for 15 seconds. Remove the cast and allow it to cool. This well seal
the cast and provide a smooth, dense surface for waxing. Set the refractory
cast aside in a safe place where it will not be damaged and begin the pattern
by fabricating resin copings.
PATTERN ARMAMENTARIUM :
1) Stone die.
2) Saw frame, jeweler’s blade
3) Die lubricant, small brush
4) Monomer and polymer
5) Dapper dishes (2)
6) Straight hand piece, sandpaper disk mandrel, large acrylic bur
7) Iwanson thickness gauge
8) Bunsen burner, PKT no. 2 waxing instruments , beaver-tail burnisher.
9) Blue inlay wax.
10) Hollenback carver, cleoid carver, spoon excavator
11) Cotton pliers
RESIN COPING FABRICATION :
Make a second pour in densite stone, of just the prepared abutment
teeth in the master impression. After the stone has set, remove the cast from
the impression and trim away any excess stone from the preparations.
Separate the prepared teeth with either a saw or separating disk. Trim the
dies thus formed, removing the stone apical to the gingival finish lines
without producing any marked concavity in the area.
Apply an oily die lubricant to each of the dies and shake off the
excess. Apply one or two drops of monomer to each die.Sprinkle on enough
polymer to cover the entire surface of the preparation. Add another drop of
monomer and repeat the process until the lingual surface of the die is
covered with resin. Place each die in water to allow polymerization to occur
without evaporation of the monomer. Tease the resin coping of the die.
Remove the thin area of marginal flash by rubbing your fingertip across the
margin. Any areas that are too thick to be removed in this fashion should be
trimmed with a sandpaper disk.
 Cut the margins back 0.5 to 1.0mm so they do not extend all the way
to the finish lines. This will allow sealing of margins in wax on the
refractory cast later when the entire pattern has been completed. Place the
copings back on their respective dies to insure that all the margins have been
sufficiently relieved.
Lubricate the stone master cast with the same oily die lubricant used
on the dies. Transfer the copings to the stone master cast; build a small
projection into the edentulous space from the proximal surface of each
coping, dipping a small brush first into monomer and then polymer. Do not
build them into contact at this time. Set the cast aside for a while and allow
the resin to polymerize. This allows much of the shrinkage distortion to
occur before the retainers are joined together into one piece, where the
shrinkage could warp the fixed partial denture framework.
Examine the lingual thickness of the resin copings and adjoining bar.
Check them in occlusion against the opposing cast, and if they are too thick,
remove the excess with a large acrylic bur. Remove the pattern from the cast
and check the thickness of the lingual surface of the retainer resin copings
with an lwanson thickness gauge. The thickness should be no less than
0.4mm and preferably closer to 0.6mm.
WAX PATTERN :
Add blue inlay wax to the bar of resin connecting two retainers. Build
up the wax to the full contour of the final pontic. Carve it flush or the
lingual surface of resin bar. If there are any voids in the resin, fill them in
with wax and carve them. Use a spoon excavator or a discoid carver to cut
1.0mm deep grooves into the facial, lingual and gingival surfaces of the
pontic. The grooves on the incisal edge should be 1.5mm deep. These
grooves will insure an adequate thickness of porcelain when it is added to
the metal framework later. Carve away the wax to the depth of the full-sized
pontic in the cutback version.
 To insure uniform space for porcelain under the pontic, and to prevent
overshortening of the supportive metal framework in the gingival area, no
space should be visible under the pontic when it is viewed from facial
surface. However, when the cast is tilted, there should be space under the
pontic when it is viewed from a gingivo- facial or inciso-lingual direction.
Retrieve the refractory cast and, without painting any lubricant on the
cast, transfer the pattern to it. Add blue inlay wax around the entire
periphery of both retainer copings with a PKT No. 2 waxing instrument.
The wax pattern will not be removed from the cast, and investing will take
place directly on it. Carefully carve the margins with a heated, dull-edged
beavertail burnisher on the facial and lingual surfaces.
INVESTING AND CASTING ARMAMENTAINUM :
1) Bunsen burner
2) Cotton pliers, brush
3) Hollenback carver, PKT no. 2 waxing instrument.
4) 8-gauge wax sprue, conical metal sprue former
5) 500-cc Vac-U-Mixer, Vacuum tubing
6) Investment, split casting ring
7) Vibrator.
8) Water measure, spatula
9) Modelling clay, 5-inch plastic square.
10) Bench knife.
11) 8.0 dwt of casting alloy.
INVESTING AND CASTING :
Attach an 8-gauge wax sprue to the lingual surface of the pontic. Cut
it off over the hole in the palate that will accommodate the conical metal
sprue former . Then insert the sprue former through the hole until the cone
is completely seated. It should contact the end of the wax sprue, or come
close to it. Attach the wax sprue smoothly to the metal sprue former.
 Vacuum mix the investment material, and with a large brush flow the
material on the lingual surface of the pattern, painting investment around all
the margins and under the wax sprue. Be sure to paint investment under the
pontic so all that space is completely filled with investment.The hand
holding, the brush is rested on the vibrator, but the cast itself is not vibrated.
Turn the cast over and paint material on the facial surface of the anterior
portion of the refractory cast. Take care to paint investment along all of the
facial margins of the retainers.
With modelling clay, seal a split casting ring to a 5-inch ceramic tile
or plastic square. Then fill the spit ring with investment flush with the top.
Grasping the cast by its sides, place the molar end of the cast into the
investment in the center of the ring. Wiggling the cast gently, immerse it
completely in the investment, rotating it 90 degrees to an inverted position
with the base of the cast parallel with the bottom of thee ring. The teeth on
the cast are toward the table, and the metal sprue former should protrude
slightly from the investment.
When the investment has set completely, remove the investment filled
ring from its base. Use a bench knife to bevel in to the base of metal sprue
former. When there is adequate access to grasp the sprue former, remove it
from the investment. Burn out the invested pattern in a burnout furnace,
going from room temperature to 7320C (13500F) in 45 minutes.Soak the ring
at that temperature for 90 minutes. Transfer the ring to the cradle of an
induction casting machine and cast the fixed partial denture with a sufficient
weight of suitable casting alloy.
Allow the ring to cool to room temperature before breaking the
casting out. After removing the large pieces of the investment with sharp
instruments, remove the final layer with aluminium oxide air abrasion.
Porcelain can be added at this point, although the novice operator
would be well-advised to try the casting in the mouth to insure its fit before
proceeding. Even the metal framework is tried in, there will be a try-in after
porcelain has been added to insure the maximum esthetic result.
DELIVERY ARMAMENTARIUM :
1) Rubber dam, clamp and frame
2) Low-speed, contra angle handpeice, rubber prophy cup, pumice.
3) Etchant, cotton pellets
4) Small brush, mixing well
5) Mixing pad, plastic spatula
6) Mylar strip, dental floss
7) Explorer, scaler
8) Complete adhesive resin kit.
CEMENTS (BONDING AGENTS) :
Composite resins play an important role in bonding the metal
framework to etched enamel. A variety of resin adhesives have been
introduced specifically for this purpose. Conventional BIS-GMA type
resins, originally used for lutting resin-retained FPDs have been replaced by
these more recently developed resin-metal adhesives, which continue to
improve.
Panavia is an adhesive monomer, glass-filled BIS-GMA composite
has a long history of successful application. Panavia exhibits excellent bond
strengths to base metal alloys and tin-plated noble metals. It has an
anaerobic setting reaction and will not set in presence of oxygen. To ensure
a complete cure, the manufacturer provides a polyethylene glycol gel
(Oxyguard II) that can be placed over restoration margins. The gel creates
an oxygen barrier and can be washed away after the material has completely
set The latest version of this cement is both chemically and light cured, as
an alternative to the oxygaurd II, a curing light can be used to polymerize
the margins.
According to Caughman W.F. et al : JPD 1987; 58, 48-49 :
Panavia is supplied in opaque and tooth-coloured (TC) forms. Both
can be mixed and application of opaque to the lingual of anterior retainer
and translucent tooth colour to the interproximal so that opaque line is not
visible from the facial. This method makes it possible to mark the unesthetic
metallic gray retainer, thus preventing it from showing through translucent
enamel. One disadvantage is need for both type of resin cements.
EPOXYLITE CBA 9080 :
It is available as powder-liquid system. When mixed, it is opaque
white in colour and has a 4-minute set time.
COMSPAN :
Perhaps the best known of the composite lutting agents for direct
bonded retainers is that of comspan. It was developed specifically for use
with etched metal retainers.It is composed of two parts. The first part is
composed of two liquids, that when mixed, form the unfilled resin. The
second part is composed of two pastes that are mixed together to form the
filled resin. Working time is about 2 minutes and 50 seconds. It is a tooth-
coloured, translucent material.
A later entry into the field by the same company is comspan opaque
which has 10 seconds longer setting time.
RETAIN :
It is a two-paste filled resin. It is tooth coloured. By adding more base
in the proportions of 3:7, a dentist can increase the setting time to 190
seconds.
KERR RESIN BONDED BRIDGE CEMENT :
It is a two-part system with a two-paste filled resin. The standard kit
comes with two different paste bases, one of which is opaque paste and the
other a translucent tooth-coloured paste. The percentage of inorganic filler
is lowered to 48% in order to increase the flow characteristics under
pressure. It has the lowest film thickness (10m).
DEN-MAT CROWN RELINE MATERIAL :
It is a two-part, two-paste, tooth-coloured material. One advantage of
this material is that setting time is quite easily varied by the operator. The
setting time ranges between 150 seconds to 405 seconds. It has a great film
thickness (40 m-66m).
CONCLUDE :
It is an opaque, two-paste composite of exceptional strength. The
particle size is about 25m to a allow for a thinner film thickness and the
pastes have a lower load to provide easier flow. The proportion of
accelerator has been decreased to allow for more working time. Setting time
is between 125 seconds to 240 seconds.
DELIVERY SEQUENCE :
The technique described here is for Panavia 21.
The process begins with the isolation of the abutment teeth with a
rubber dam. Refresh the tooth facing surfaces of the retainers by air
abrading them again just before inserting the restoration. Use 30-50m
aluminium oxide with a hand held etcher. Two to three seconds at 4.7 to
7Kg/cm2 (60-100Psi) pressure should be sufficient to restore the matte
finish. Wash the cast in running water for 1 minute, place it in dish washing
liquid in an ultrasonic unit for 2 minutes, and then rinse.
If the FPD is made of high noble alloy, the inner surface of the
retainers should now be plated with a layer of tin approximately 0.5m
thick. Ground the tin plating instrument to the pontic metal.
The next step is to clean the tooth preparations with unflavoured, non
fluoridated pumice and a rubber prophy cup. Wash off the pumice and apply
a 40% to 50% phosphoric acid solution to the abutment preparations with a
cotton pellet. Leave the etchant on for 60 seconds, rinse, dry, and reapply
for 15 seconds. Wash the abutment preparations thoroughly with water for
20 seconds, followed by drying. Play a light stream of air over the
preparation. Place a Mylar strip between each abutment and the
neighbouring tooth.
Then mix the primer and the resin in mixing dish for 4 seconds to
bond the prosthesis in place. Use a sponge pledget to apply the mixture to
the preparation. Allow it to set for 60 seconds and then apply a gentle
stream of air to evaporate the volatile substances, leaving a glossy surface.
Do not apply primer to the metal; do not rinse. Mix the two stripes of paste
over wide area because spreading it out will keep it from setting
prematurely since it is anaerobic.
Apply a thin, bubble free layer of paste to the retainers. This layer of
mixed resin is applied to the retainers and seat the restoration with firm
finger pressure and hold it for 60 seconds. Use a small brush to clean away
excess resin. Light cure the margins or use a disposable brush to apply
Oxygaurd II to the margins of the retainers to keep oxygen away from the
setting resin. The Mylar strips between each abutment tooth and the tooth
adjacent will ensure that they do not bond together. A piece of floss can
also be positioned between the abutment tooth and its neighbour when the
FPD is placed. It is pulled out through the contacts before the resin has set
completely. After 5 minutes remove the Oxygaurd II with cotton rolls and a
water spray.
Before the resin has become too hard, the excess must be removed
because it will become irritating to the gingival tissues. Major finishing,
polishing and occlusal adjustments should be performed before bonding the
restoration; otherwise the tensile strength of bonded prosthesis is adversely
affected by the heat or vibrations produced with rotary instruments.
POST OPERATIVE CARE :
All resin-bonded restorations should be scrutinized at the regular
recall examinations. Since debonding or partial debonding can occur
without complete loss of the prosthesis, visual examination and gentle
pressure with an explorer should be performed to confirm such a
complication. Because debonding is most commonly associated with biting
or chewing hard food, patients should be warned about this danger. If a
patient perceives any changes in the restoration, he or she should seek early
attention. Early diagnosis and treatment of a partial debonded prosthesis can
prevent significant caries.
According to Gilmour A.S.M. : Br Dent J 1989; 167, 140-141 :
He described a fixed-fixed, resin-bonded bridge which became
debonded from one of two retainers for an extended period. The extent of
the resultant carious lesion beneath the debonded retainer underlines the
importance of regular examination of these restorations, not only to check
for debonding, but also to monitor enamel demineralization associated with
plaque retention around the periphery of the retainers.
The restoration can be rebonded successfully. If a prosthesis debonds
more than twice, reevaluating the preparation and remaking the prosthesis
is probably necessary.
Attention to periodontal health is critical, because the retainer design
has the potential to accumulate excess plaque as a result of lingual
overcontouring and the gingival extent of margins.
According to Romberg E. et al : J. Periodontol 1995; 66, 973-977 :
They studied the periodontal response to resin-bonded bridges over a
period of 10 years. They concluded that the overall long-term periodontal is
favorable.
 The patient should be taught appropriate plaque-control measures.
Calculus removal with hand instruments is recommended over ultrasonic
scalers to reduce the chance of debonding.
BONDED PONTICS :
The earliest resin-retained prosthesis were extracted natural teeth or
acrylic teeth used as pontics bonded to the proximal and lingual surfaces of
the abutment teeth with composite resin. The composite resin connectors
were brittle and required supporting wire or a stainless steel mesh
framework. These bonded pontics were limited to short anterior spans and
had a limited lifetime with degradation of the composite resin bond to the
wire or mesh and subsequent fracture. Such restorations should only be
presented to patients as short term replacements.
According to R.E. Jordan et al : JADA 1978; 76, 994-1001 :
They reported a follow up study of 3 years for 86 cases who were
given temporary fixed partial denture. They concluded that:
1) Dislodgement of resin pontic almost invariably occurred as a
cohesive fracture with in the back of the bonding resin.
2) For cases of short term, in which the expected longevity requirement
for the restoration is between three and nine months, acid-etch resin
technique alone may be used.
3) If expected longevity is from a year to three or more years, accessory
stabilization of prosthesis by means of pins is recommended.
CAST PERFORATED RESIN RETAINED FPDs (MECHANICAL
RETENUON) “ROCHETTE BRIDGE” :
In 1973, Rochette introduced the concept of bonding metal to teeth
using flared perforations of the metal casting to provide mechanical
retention. He used the technique principally for periodontal splinting but
also included pontics in his design. So the first use of wing like retainers,
with funnel-shaped perforations through them to enhance resin retention is
attributed to Rochette, who combined mechanical retention with a silane
coupling agent to produce adhesion to metal. The perforated retainer
became the standard design for several years, being used for both anterior
and posterior fixed partial dentures.
The perforation technique has the following limitations :
 Weakening of the metal retainer by the perforations.
 Exposure to wear of resin at the perforations.
 Limited adhesion of metal provided by the perforations.
According to William V.D. et al : JPD 1982; 48, 417-423 :
They did a study to know the effect of design of retainer on the
retention of resin bonded fixed partial dentures. They concluded that
retainer of 0.5mm thickness with small holes (0.7mm diameter made with
No. ½ bur) and retainer of 0.5mm thickness with reinforced mesh grid had
the highest tooth breakage at 55% and 66% respectively on application of
compressive shear torque force. Retainer with finger design had the lowest
tooth breakage of 11%.
According to Boyer D.B. et al : J Dent Res 1993; 72, 1244-1248 :
For anterior fixed partial dentures, 63% of the perforated retainer
prosthesis fail in about 130 months.
ETCHED CAST RESIN-RETAINED FPDs (MICRO-MECHANICAL
RETENTION – “ MARYLAND BRIDGE”) :
Livaditis and Thompson at the University of Maryland developed a
technique for the electrolytic etching of Ni-Cr and Cr-Co alloys.
According to Livaditis J. et al : JPD 1982; 47, 52-58 :
They used a 3.5% solution of nitric acid with a current of 250
mA/Cm2 for 5 minutes, followed by immersion in an 18% hydrochloric acid
solution in an ultrasonic cleaner for 10 minutes, to etch the internal surfaces
of solid base metal retainers for resin-bonded fixed partial dentures.
 This type of etched metal prosthesis is frequently called the Maryland
Bridge.
Etched cast retainers have definite advantages over the cast perforated
restorations :
 Retention is improved because the resin-to-etched metal bond can be
substantially stronger than resin-to-etched enamel. The retainers can
be thinner and still resist flexing.
 The oral surface of the cast retainers is highly polished and resists
plaque accumulation.
Since composite resin with a low film thickness for lutting the casting
became apparent, so there was development of resin cements, which
permitted micromechanical bonding in to the undercuts in the metal casting
created by etching while providing adequate strength and allowing complete
seating of cast retainer.
Electrochemical etching is technique sensitive.Overetching produces
an electropolished surface, and contamination of surface reduces bond
strength.
A form of chemical etching with a stable aqua regia gel was
substituted for electrochemical etching by Doukoudakis. The use of acid gel
requires no special equipment and the prosthesis can be fabricated and
bonded in just two clinical sessions.
According to Dhillon. et al : J Dent Res1983; 62, 304 :
They found that an electrochemically etched surface was
approximately 2.9 times as retentive as a perforated one.
According to Re. G. J et al : JPD 1988; 59, 568-573 :
Retainers coated with pyrolized silane have been shown to be 47% to
104% more retentive than retainers treated by etching alone.
According to Mukai. M et al : JPD 1995, 74, 151-155:
Air abrading metal with 250 m abrasive increase bonding strength
remarkably when used in conjunction with silane.
MACROSCOPIC MECHANICAL RETENTION RESIN-RETAINED
FPDs (“VIRGINIA BRIDGE”)
Moon and Hudgins et al produce particle-roughened retainers by
incorporating salt crystals in to the retainer patterns to produce roughness on
the inner surfaces. In this method, also known as lost salt technique for
producing Virginia bridges, the frame work is outlined on the die with a
wax pencil, and the area to be bonded is coated first with model spray and
then with lubricant.Sieved cubic salt crystals (NaCl), ranging in size from
149 to 250 m, are sprinkled over the outlined area. The retainer patterns
are fabricated from resin, leaving a 0.5 to 1.0 mm wide, crystal free margin
around the outlined area.
When the resin has polymerized, the patterns are removed from the
cast, cleaned with a solvent, and then placed in water in an ultrasonic
cleaner to dissolve the salt crystals. This leaves cubic voids in the surface
that are reproduced in the cast retainers, producing retention for fixed partial
denture.
According to El-Sherif M.H. et al : JPD 1991; 65, 782-786 :
Retainers fabricated by this technique could be 30% to 150% more
retentive than retainers prepared by electochemical technique depending on
the resin used. Air abrasion with aluminium oxide has been used as the sole
means of surface treatment, as well as the precursor for other treatments.
According to Tanaka .J et al : JPD 1988; 60, 271-279 :
They created a suitable surface for bonding with the 4-meta resin by
inducing a heat-accumulated copper oxide deposit on noble-metal alloys in
conjunction with 50 m aluminium oxide air abrasion.
CAST MESH FIXED PARTIAL DENTURE :
Techniques that produce roughness before the alloy is cast, or use a
nonetching method after casting, have also been employed. A net like nylon
mesh (Klett-O-Bond) can be placed over the lingual surfaces of the
abutment teeth on the working cast. It is then covered by and incorporated
into the retainer wax pattern, with the undersurface of the retainer becoming
a mesh-like surface when the retainer is casted. It eliminates the need for
etching, and it permits the use of noble metal alloys. The material tends to
be stiff, making it somewhat difficult to adapt to detail of the abutment
tooth, and if wax runs too freely into the mesh, blocking out the undercuts,
the retentive ability is compromised.
CHEMICAL BONDING RESIN-RETAINED FPDs (ADHESION
BRIDGES) :
The first of these resin systems i.e. Super-bond is based on
formulation of methyl methacrylate polymer powder and MMA liquid
modified with adhesion promotor 4-META. It was developed with a unique
tri-n-butylborane catalyst system that is added to the liquid before
combining with the powder. Super-bond has the highest initial bond
strengths of any adhesive resin system. Unfortunately, there is some concern
about the hydrolytic stability of these bonds over time, which depends on
the alloy’s Cr-Ni ratio.
According to Salonga J.P. et al : JPD 1994; 72, 582-584 :
They evaluated the influence of chromium content on both strength
and durability between Ni-Cr alloys and an adhesive resin that contained 4-
methacryloxyethyl trimellitate anhydride. The results suggest that Ni-Cr
alloys with higher Cr content are desirable for 4-methacryloxyethyl
trimellitate anhydride resin-bonded restorations.
Super-bond advantages includes its lower elastic modules and higher
fracture toughness when compared to BISGMA – based resin cements,
which could result in less brittleness and better clinical results with less well
adapted castings.
Panavia is also used as an adhesive cement for such bridges.
According to Omura. I et al : J Dent Res 1984; 63, 233 :
Panavia has excellent bonds to air-abraded Ni-Cr and Cr-Co alloys.
FIBRE-REINFORCED COMPOSITES :
Fibre reinforced composites (FRCS) are a class of materials in which
the basic properties of the polymers are given mechanical reinforcement by
addition of fibrous materials such as glass, carbon/graphite, or aramid fibres.
The optimum properties of a reinforced resin cannot be obtained unless
there is an effective bond between two phases. Other factors which
influence the physical properties of FRCs considerably are impregnation of
the fibres within the resin matrix, the quantity of reinforcing fibres and the
orientation of the fibres. Fibres which are silanised have good adhesion to
polymer matrix.
INDICATIONS :
1) The need for a restoration with excellent appearance.
2) Can be used in patients who are allergic to metals.
3) They have a good flexural strength.
4) They decrease wear of opposing dentition.
5) The use of conservative intracoronal abutment tooth preparations.
CONTRAINDICATIONS :
1) Inability to maintain good fluid control e.g. in patients with chronic or
acute gingival inflammation or when margins would be placed deeply
into sulcus.
2) Long span i.e. two or more pontics.
3) Patients with Para functional habits.
4) Patients with unglazed porcelain or removable partial denture
frameworks that would oppose the restoration.
 5) Patients who use alcoholic substances.
RESIN-BONDED BRIDGES IN OCCLUSAL TREATMENT :
The use in the building of acid etch lingual ramps on maxillary canines is
to effect a canine disclusion.
INDICATIONS :
1) If the patients has abraded natural canines.
2) Patients with group function, occlusion.
3) If clinician feels that the patient would function better in a canine
protected occlusion.
According to Mayer K.E et al : JPD 1981; 46, 149-152 :
They described a technique where metal canine risers were attached
to lingual surfaces of maxillary canine teeth with acid-etch composite resin.
The castings created a canine protected occlusal scheme. No enamel needed
to be removed from the teeth in their preparation for restorations. The
procedure is simple, safe, inexpensive, and effective.
CONCLUSION :
One of the basic principles of tooth preparation for fixed
prosthodontics is conservation of tooth structure. This is the primary
advantage of resin-retained fixed partial dentures. Precision and attention to
detail are just as important in resin-retained fixed partial dentures as they are
in conventional prosthesis. To provide a long-lasting prosthesis, the
practitioner must plan and fabricate a resin-retained restoration with the
same diligence used for conventional restorations. The techniques can be
very rewarding but must be approached carefully. Careful patient selection
is an important factor in predetermining clinical success.
LIST OF REFERENCES :
1) Fundamental of fixed prosthodontics : Herbert. T. Shillingburg : 3 rd
edition.
2) Contemporary fixed prosthodontics : Rosenstiel : 3rd edition.
3) Fixed prosthodontics : Keith E. Mayer
4) Johnston’s Modern practice in fixed prosthodontics : Roland W.
Dykema, Charles J. Goodacre, Ralph W. Philips : 4th edition.
5) A textbook of fixed prosthodontics : Stig Karlsson, Krister Nilner,
Bjorn L Dahl,
6) Glossary of Prosthodontic terms 7th edition.
7) Etched cast restorations : clinical and laboratory techniques : Richard
simonsen / Van Thompson / Gerald Barrack
8) Direct bonded retainers – the Advance alternative : Gerald Mc
Laughlin.

9) Removal of acid-etched fixed partial dentures with modified

ultrasonic scaler tips : Jordan RD, Krell KV, Aquilino SA, Denchy
GE, Svare CW, Mayer KE, Williams KD : JADA 1986; 112: 505-
507.
10) Cast metal, resin-bonded prosthesis : A 10 year introspective study :
Williams VD, Mayer K.E., Denchy G.E., and Daniel B : JPD 1989,
61: 436-441.
11) Experience with resin-bonded bridges and splints – A retrospective
study : Marinello Q. Kerschbaum T, Heinberg B, Hinz R, Peters S,
Pfeiffer P, Reppel PD, schwickerath 4: J Oral Rehabil 1987; 14:251-
260
12) Clinical performance of resin-bonded cast metal fixed partial
dentures (Rochette fixed partial dentures) : Shaw MJ, Jay WM, Br.
Dent J 1982; 152: 378-380.
13) Particle-roughened resin-bonded retainers: Hudgins JL, Moon PC,
Knap FJ : JPD 1985; 53: 471-476.
14) A four year clinical evaluation of resin-bonded fixed partial
dentures : Priest GF, Donltelli HA : JPD 1988; 59: 542-546.
15) Clinical performance of resin-bonded bridges : a 5 year
retrospective study II : Creugers NHJ, Snoek P.A, Van’t Hof M.A.
and Kayser A.F : J Oral Rehabil 1989; 16: 521-527.
16) Attachment of a splint to enamel of lower anterior teeth : Rochette
AL : JPD 1973; 30: 418-423.
17) Experiences with resin-bonded fixed partial dentures and splints – A
cross sectional retrospective study, part II : Marinello CP,
Kerschbaum T, Heinenberg B, Hinz R, Peters S, Pfeiffer P, Reppel
PD, Schwickerath H : J Oral Rehabil 1988; 15: 223-235.
18) Resin-bonded fixed partial dentures : A recall study : Chang HK,
Zidan O, Lee IK, Gomez-Marin O : JPD 1991; 65: 778-781.
19) Anterior retainer design for resin-bonded acid-etched fixed partial
denture : Burgess JO, McCartney JG : JPD 1989; 61: 433-436.
20) Improved retention of acid-etched fixed partial denture : A
longitudinal study : Simon JF, Gartrell R.G, Grogono A : JPD
19902; 68: 611-615.
21) A Comparison of bond strengths of adhesive cast restorations using
different designs, bonding agents, and luting agents : Pegoraro LF,
Barrack G : JPD 1987; 57: 133-138.
22) In Vitro marginal leakage of acid-etched composite resin bonded
castings : Humbree JH, Sneed WD, Looper S : Quintessence Int.
1986; 16: 539-545.
23) Tooth Preparation designs for resin-bonded fixed partial dentures
related to enamel thickness : J.R. Eshleman, C.E. James, and C.R.
Jones : JPD 1988; 60: 18-22.
24) A classification of Resin bonded bridges based on the evolutionary
changes of the different technique types : William A. Wiltshire,
Maryna R. Ferreira : Quintessence of Dental Technology 1987; 11:
253-258.
25) Analysis of stresses in resin bonded fixed partial dentures : Caputo
A.A, Gonidis D, Matyas J : Quintessence Int. 1986; 17: 89-93.
26) An improved retentive mechanism for resin-bonded retainers :
Livaditis J, Thompson VP : JPD 1982; 47: 52-58.
27) Bond strengths of composite to perforated and etched metal surfaces
: Dhillon M, Fenton AH, Watson PA : J Dent Res 1983; 62, 305.
28) Shear bond strength and scanning electron microscope evaluation of
three different retentive methods for resin bonded retainers : Re GJ,
Kaiser DA, Malove WM, Garcia-Godoy F : JPD 1988; 59: 568-573.
29) Relationship between sandblasting and composite resin-alloy bond
strength by a silica coating : JPD 1995; 74: 151-155.
30) The effects of alloy surface treatments and resins on the retention of
resin-bonded retainers : El-Sherif MH, El-Messery A, Halhoul MN :
JPD 1991; 65: 782-786.
31) Surface treatment of gold alloys for adhesion : Tanaka T, Atssuta
M, Nakabayashi N, Masuhara E, Nagata K, Takeyama M : JPD
1988; 60: 271-279.
32) Adhesive and mechanical properties of a new dental adhesive : I
Omurey J. Tamauchi, I-Harada and T. Wada : J Dent Res; 1984; 63,
233.
33) Bond strength of adhesive resin to three Ni-Cr alloys with varying
chromium content : Johnny-P-Salonga, Hideo Matsumura,
K.Yasuda, Y. Yamabe : JPD 1994; 72: 582-584.
34) The effect of retainer design on the retention of filled resin in acid-
etched fixed partial denture : V.D. Williams, D.G. Drennon, and
L.M. Silverstone : JPD 1982; 48, 417-423.
35) Analysis of debond rates of Resin-Bonded Prosthesis : D.B. Boyer,
V.D. Williams, K.E. Mayer, G.E. Deneky, and A.M. Diaz-Arnold : J
Dent Res 1993; 72, 1244-1248.
36) A double-mix cementation for improved esthetics of resin-bonded
prosthesis : W.F. Caughman, C-Douglas Smith, and Larry. C.
Breeding : JPD 1987; 58, 48-49.
37) Resin-bonded bridges : a note of caution : A.S.M. Gilmour, Br.
Dent J. 1989; 167, 140-141.
38) 10 – year periodontal response to resin-bonded bridges : J.
Peridontol 1995; 66, 973-977.
39) Temporary fixed partial dentures fabricated by means of the acid
etch resin technique : a report of 86 cases followed for up to three
years : R.E. Jordan, M. Suzuki, P.S. Sills, D.R. Gratton, and J.A.
Gwinnitt : JADA 1978; 96, 994-1001.
40) Chair side prefabricated fibre-reinfored resin composite fixed partial
dentures : Jonathan C. Mecirs, Marlin A. Freilich : Quintessence Int.
2001; V-1(2), 43-48.
41) Acid-etch canine resin occlusal treatment : Keith E. Mayer, and
Asterios Doukoudakis : JPD 1981; 46, 149-152.
 ETCHED CAST RESTORATIONS
1. Introduction
2. Definition
3. History
4. Requisites
5. Classification
6. Advantages
7. Disadvantages
8. Indications
9. Contraindications
10.Anterior tooth preparation
11.Posterior tooth Preparation
12.Framework Fabrication
13.Master cast Duplication
14.Resin Coping Fabrication
15.Wax Pattern
16.Investing and Casting
17. Cementation
18. Post operative Care
19. Bonded Pontics
20. Rochette Bridge
21. Maryland Bridge
22. Virginia Bridge
23.Cast Mesh Fixed Partial Denture
24. Adhesive Bridge
25.Fibre Reinforced composites
26.Resin Bonded Bridges in occlusal Treatment
27. Conclusion
28. List of References
 DEPARTMENT OF PROSTHODONTICS
INCLUDING CROWN AND BRIDGE

COLLEGE OF DENTAL SCIENCES

DAVANGERE

SEMINAR ON

STABILITY

IN COMPLETE DENTURE

Presented By
DR. NITIN GAUTAM
(2001 – 2002)