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103]

Case Report

Different techniques for management of pier

abutment: Reports of three cases with review
of literature
Puja Hazari, Surabhi Somkuwar, Naveen S. Yadav, Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples Dental Academy, Bhopal, Madhya Pradesh, India

ABSTRACT
For restoration of arches with pier abutments, if a rigid connector is used and occlusal load is applied on the abutment teeth at one
end of fixed partial denture (FPD), it results in the pier abutment acting as a fulcrum. It will tend to lift the other end like a Class
I lever causing stress on the terminal abutments and ultimately failure of the FPD and trauma to the periodontium. The purpose
of this article is to summarize various treatment approaches to minimize the effect of forces in long span bridges given in cases
of pier abutment.

Key Words: Nonrigid connector, pier abutment, precision attachment

Introduction abutments since under occlusal load maximum stresses

are concentrated on them. Selection of the right type of
The occlusal forces applied to a fixed partial denture (FPD) connector can make a real difference between success and
are transmitted to the supporting structures through the failure.[3] Researchers had given different opinions about
pontic, connectors, and retainers.[1] An FPD with the pontic nonrigid connectors which are tabulated in Table 1.[4-12] The
rigidly fixed to the retainer provides adequate strength and purpose of this article is to summarize various treatment
stability to the prosthesis and also minimizes the stresses approaches to minimize the effect of forces in long span
associated with the restoration. But if an edentulous space bridges given in cases of pier abutment. The treatment
occurs on both sides of a tooth, creating a pier abutment options in case of pier abutment are implant in edentulous
then physiologic tooth movement, arch position of the spaces or FPD with nonrigid connectors, using precision
abutment, and a disparity in the retentive capacity of the and semi-precision attachments.
retainers can make a 5-unit FPD a less than ideal plan
of treatment.[2] Pontic are considered as heartthrob of This is an open access article distributed under the terms of the
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DOI: How to cite this article: Hazari P, Somkuwar S, Yadav NS, Mishra SK.
10.4103/2321-4848.183343 Different techniques for management of pier abutment: Reports of three cases
with review of literature. Arch Med Health Sci 2016;4:89-92.

Corresponding Author:
Dr. Sunil Kumar Mishra, Department of Maxillofacial Prosthodontics and Implantology, Peoples Dental Academy, Bhopal,
Madhya Pradesh, India. E-mail: drsunilmishra19@gmail.com

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Hazari, et al.: Management of pier abutment

Case Reports endodontically treated, it was also restored with a porcelain

fused to metal restoration [Figure 2].
Case 1
Restoration using independent implant-supported restorations Case 2
A 55-year-old patient presented with missing maxillary Restoration using prefabricated precision attachments
first premolar (14) and first molar (16) on the right side. A 52-year-old patient visited the Department of
The second premolar (15) was a pier abutment. After Prosthodontics with a chief complaint of inability to masticate
complete radiological and medical examination, two implants and poor esthetics. Intraoral examination revealed missing
supported restorations for each missing tooth were planned. first molar (16) and second molar (17) of maxillary right
Orthopantomograph was taken, bone mapping was done, side and missing first premolar (24) and first molar (26)
and implant sizes were determined. In 16 area and 14 area, of the maxillary left side with deep bite. After discussing
the first stage surgery was done and an implant fixture all the treatment options, it was decided to rehabilitate
measuring 3.75 mm × 8 mm and 2.8 mm × 10 mm (Adin, the case with 5-unit FDP using nonrigid connectors on
Israel), respectively, were placed. A shorter implant was the distal aspect of pier abutment and an FDP using rigid
placed in 16 area due to the proximity of the maxillary sinus. connector on the right side. A precision attachment (Vario
A narrower implant was placed in 14 area due to prominent Soft 3, Bredent, Germany) was selected for this case. It
canine fossa and thinner cortical plate in that area [Figure 1]. had frictional retention, plastic pattern male and female,
After a waiting period of 6 months for osseointegration, the with built in paralleling mandrels. Tooth preparations were
second stage surgery was done, and porcelain fused to metal done with respect to canine (23), second premolar (25),
restorations were placed. As the pier abutment, 15 was also and second molar (27) on left side and impressions were
made. Wax pattern was fabricated with patrix/male as a part
Figure 1: Intraoral radiograph showing implants placed adjacent
to pier abutment Figure 2: Final implant retained prosthesis

Table 1: Review of literature

Author Summary of study
Broken (1951)[4] NRC should be placed at one of the terminal retainer
Gill (1952)[5] Suggested that NRC can be placed at one or both sides of pier abutment
Adams (1956)[6] Suggested placing NRC on the distal aspect of pier abutment and if required then add one more on the distal aspect of anterior retainer
Shillingburg and Fisher (1973)[7] Suggested that patrix part should be prepared within the contours of retainer and matrix is attached to the distal pontic
Standlee and Caputo (1988)[8] Suggested that tension between the terminal retainers and their respective abutments, rather than a pier fulcrum, is the mechanism of failure
Nishimura et al. (1999)[9] Studied the stress transfer patterns with variable implant support and simulated natural teeth through rigid and nonrigid connection under simulated functional
loads and concluded that rigid connector in particular situations caused only slightly higher stresses in the supporting structure and demonstrated more
widespread stress transfer
Misch (2005)[10] Suggested that in conventional FDP, the “male” portion of a nonrigid attachment usually is placed on the mesial aspect of the posterior pontic, whereas the
“female” portion is attached to the distal aspect of the natural pier abutment tooth. This prevents mesial drift from unseating of attachment. However, an implant
does not undergo mesial drifting, and the NRC location is more flexible. For a natural pier abutment between two implants, a stress breaker is not indicated
Savion et al. (2006)[11] Suggested that the possible etiology behind debonding is due to development of extrusive reactive forces at anterior abutment and flexural forces in posterior
abutment
Oruc et al. (2008)[12] Observed that the stress distribution and values of an FPD and pier abutment are affected by the presence and location of an NRC. Distal region of pier
abutment is considered the area of minimum stress concentration
NRC = Nonrigid connectors, FDP = Fixed dental prosthesis

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Hazari, et al.: Management of pier abutment

of pontic pattern and matrix/female as a part of a crown the impression of the female portion with accuracy. Second
pattern. Accurate alignment of female part is crucial. This casting was done with a tenon (male) portion attached to
is accomplished with a dental surveyor. After casting, metal the pontic. Metal try-in of the second segment was done
try-in of the individual units was done to verify proper seating and proper key-keyway fitting was verified. Ceramic build
and then finally restorations were finished [Figure 3]. Mesial up was done. The second segment was cemented [Figure 7].
3-unit bridge with keyway was cemented first and then distal
2-unit bridge with key was cemented with glass ionomer Discussion
cement (GC, Fuji, America) [Figure 4].
The existence of pier abutment which promotes a fulcrum-
Case 3
like situation that can cause the weakest of the terminal
Restoration using customized semi-precision attachments
abutments to fail and may cause the intrusion of a pier
A 30-year-old patient presented with missing mandibular
abutment.[13] There is a need for stress breakers on a pier
first premolar (44) and first molar (46) on the right side for
abutment which is supporting prosthesis on both ends as
FPD [Figure 5]. Due to financial factors, patient cannot afford
nonrigid connector so that shear stresses can be transferred
for dental implants and FPD with precision attachment.
to supporting bone rather than concentrating them in
FPD with a semi-precision attachment was fabricated
connectors. A stress breaker minimizes mesiodistal torquing
with a key-keyway or Tenon-Mortise connector. Mortise
of abutments and permits them to move independently.[14]
(female) part prepared within the contours of the wax
The bonhomie of rigid and nonrigid connectors can increase
pattern of the retainer. Casting was done and the first
segment was cemented [Figure 6]. For the second portion, the lifespan of an abutment in 5-unit FDPs as it transfers
a second impression was made. Care was taken to make less stress on the abutments. Furthermore, allowing

Figure 4: Postcementation occlusal view of 5-unit fixed movable

Figure 3: Two halves of long span bridge
prosthesis

Figure 5: Pretreatment view Figure 6: First segment with keyway cemented

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Hazari, et al.: Management of pier abutment

Figure 7: Second segment with key cemented because of medical or financial conditions nonrigid
connectors are advocated. Precision and semi-precision
attachments provide room for slight movements which
prevents loading of the pier abutment created due to
the fulcrum-like situation and increases the lifespan of
5-unit FDP.

Financial support and sponsorship

Nil.

Conflicts of interest
There are no conflicts of interest.

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