Journal of Oral Rehabilitation 2003 30; 165–170

A clinical and radiographic evaluation of fixed partial

dentures (FPDs) prepared by dental school students:
a retrospective study
N. HOCHMAN*, L. MITELMAN, P. E. HADANI† & M. ZALKIND* *Department of Prosthodontics,
Hebrew University-Hadassah School of Dental Medicine, Founded by the Alpha Omega Fraternity, Jerusalem, Israel and †Braun School of
Public Health, Jerusalem, Israel

SUMMARY In recent years, there has been an increas- FPDs were evaluated after a mean service period of
ing interest in fixed partial dentures (FPD) quality, 6Æ3 years (ranging from 1 to 25 years) after cementa-
expected lifetime and possible reasons for failure. tion. Caries was found to be the most frequent cause
This study probed the FPD success rate and the of failure and non-vital abutments decreased survi-
relationship among various factors and their effect val rates.
on FPD failure. Patients treated by dental students KEYWORDS: follow-up, fixed partial denture, FPD
under supervision and installed FPDs were exam- failure
ined clinically and radiographically. A total of 247

In prosthodontics, both biological and technical

Introduction
factors play roles in the success or failure and should
In view of their convenience and psychological and be taken into account in treatment planning.
social advantages, patients prefer reconstruction with Preventive dentistry and periodontics increasingly
fixed partial dentures (FPDs) rather than removable influence FPD procedures. Great emphasis is placed on
ones. However, the investment of time and money oral hygiene and periodontally healthy tissues prior to
involved in FPDs can only be justified if the restorations the FPD construction procedure.
are long lasting. It is only possible to monitor the patterns and rates
Various papers in the literature describe the long- of changes and determine the specific causes of
term effects of FPD treatment (Schwartz et al., 1970; failure in longitudinal studies. Such results are
Glantz et al., 1984; Leempoel et al., 1985; Randow, expected to provide dentists with valuable informa-
Glantz & Zoger, 1986; Walton, Gardner & Agar, 1986; tion for prognosis and avoiding the common pros-
Karlsson, 1989; Cheung et al., 1990; Foster, 1990; thodontic pitfalls.
Foster, 1991; Glantz et al., 1993; Leempoel et al., 1995). The aim of this study was to provide insights into the
Several interesting FPD follow-up studies of the effects survival rates of FPDs prepared by dental school
of various variables and the relationships between them students and to evaluate the causes of failure. Towards
were carried out in educational institutions (Reuter & this end, we carried out clinical and radiographic
Brose, 1984; Odman & Karlsson, 1988; Al Rafee & examinations in a randomly selected group of patients
Fayyad, 1996a,b,c; Fayyad & Al Rafee, 1997). who had been treated by students at the Hebrew
There is growing interest in the quality and expected University-Hadassah School of Dental Medicine in
longevity of such expensive treatment options among Jerusalem.
patients and insurance companies.

ª 2003 Blackwell Publishing Ltd 165

166 N . H O C H M A N et al.

Materials and methods

25

1
0
A total of 49 bridges (130 retainers and 67 pontics) in
20 female and 10 male patients and 50 single crowns in

17

1
0
14 females and nine males were studied. A total of 247
FPDs was evaluated. The patients were randomly

Caries
selected.

14

4
1
The clinical survey was conducted at a comprehen-
sive patient care clinic run by senior dental students.
Computerized data collection was carried out on

13

0
0
patients treated with FPDs by students under the

fracture
supervision of senior staff. A special assessment form

Metal
was designed. The clinical examination included a

12

1
1
dental check-up and assessment of the single crowns
and bridgework, followed by radiographic examination

11

1
0
of all the abutments. The examinations were carried
out by trained examiners (dental faculty members).

10

2
0
Among the previously standardized factors evaluated
were: periodontal condition (Silness & Löe, 1964) caries
record, oral hygiene, bridge design, pontic type,

1
0
marginal integrity, aesthetic appearance, occlusion,
mechanical condition and type material used for the

0
0
restoration. X-ray radiographs taken immediately after
cementation were compared with those in this study.

4
0
Periodontal condition, caries, fit and location of resto-

Caries and

fracture
rations and post and core types were noted.

root
To determine whether the differences between life
6

6
2
spans of two or more FPDs were statistically significant,
Table 1. Number of FPDs (bridges) evaluated several years after cementation

a t-test or ANOVA test was used. The chi-squared test was

used to determine whether the relationship between Caries
10
5

various variables and the failure rates was significant.

fracture
Root

Results
4

9
1

A total of 247 FPDs (single crowns and units in bridges)

were evaluated in this study. There were 180 retainers
3

6
0

and 67 pontics. Most of the units (90%) were made of

porcelain fused to metal (PFM). A total of 56% of the
2

3
0

FPD units examined were in women. As Table 1 shows,

six of 49 (12%) failed, three bridges were replaced after
5, 6 and 14 years because of caries; two after 4 and
1

0
0

6 years because of root fracture; and one after 12 years

because of technical failure (a fracture between two
teeth). Out of 50 single units examined, 4 (8%) failed
after cementation

No. of failed FPDs

(Table 2). Two crowns were replaced after 5 and

Reason for failure

10 years because of caries; one because of root fracture;

No. of years

No. of FPDs

and one due to periodontal involvement.

The largest group of FPDs (19Æ4%) was examined
5 years after construction (Fig. 1). The average time

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 165–170

 EVALUATION OF FIXED PARTIAL DENTURES 167

Table 2. Number of single crowns evaluated several years after cementation

No. of years after 1 2 3 4 5 6 7 8 9 10 11 12 14 19

cementation
No. of crowns 2 3 13 1 8 6 5 3 1 2 2 1 2 1
No. of failed crowns 1 1 0 0 1 0 0 0 0 1 0 0 0 0
Reason for failure Periodontal Root Caries Caries
involve- fracture
ment

elapsed until the examination was 6Æ3 years. Failure A significant relationship was found between the
rates were determined as follows: mean life span and the restorative material. The mean
No:of failed single units or units in bridges life span was 16 years for veneered acrylic, as compared
100
with 6 years for other restorative materials (P < 0Æ001).
Total no: of single units or units in
bridges examined The mean life span of FPD units was 6Æ3 years. Only 13
of 180 crowns were veneered acrylic, but they are
One of the goals was to identify the variables related
important because of their highly significant longer life
to failure. The relation between the failure rate and
span. The mean life span was higher in the over-61 age
selected variables was examined (Table 3). Statistical
group (P < 0Æ01) and in the lower as compared with the
significance was found only with respect to tooth
upper jaw (P < 0Æ01). The mean life span was found to
vitality and crown failure (single units and units in
be statistically significantly higher in a group of teeth
bridges). The failure rates were higher in teeth that had
without posts and cores (P < 0Æ05).
undergone root canal treatment (P ¼ 0Æ02) as compared
with vital teeth. Root canal treatment had been carried
out on 107 of 180 (59Æ5%) abutment teeth and four had Discussion
periapical lesions.
The prosthetic treatment described in this paper was
We defined the life span of FPDs as the lifetime of the
carried out by dental students. The efficacy of such
crown units up to the time of examination (Table 4).
restorations is of prime importance. The study was
carried out on 49 randomly selected patients rehabil-
itated with 247 FPDs. A total of 64% of the patients
were women, which is in agreement with the finding of
others that more women than men seek dental treat-
ment (Schwartz et al., 1970; Silness, 1970; Valderhaug
& Karlsen, 1976; Glantz et al., 1984; Karlsson, 1986;
Randow et al., 1986; Foster, 1990; Valderhaug, 1991;
Libby et al., 1997).
The clinic in the Faculty of Dental Medicine has the
advantage of controlled academic supervision and a
strictly scientific approach to fixed prosthodontics
(Al Rafee & Fayyad, 1996b). The Faculty staff rigorously
select the cases, avoiding those with periodontal
complications. While discharged patients from the
Dental School clinic are instructed to go to private
clinics for follow up, they often neglect this. Possibly,
some kind of referral system should be introduced to
ensure continuity of treatment.
Caries was found to be the most frequent cause of
failure, in agreement with other reports (Schwartz
et al., 1970; Glantz et al., 1984; Randow et al., 1986;
Fig. 1. Life span of FPD’s at the time of examination. Walton et al., 1986; Libby et al., 1997).

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 165–170

168 N . H O C H M A N et al.

Table 3. Success ⁄ failure of all crowns (single units and units in Table 4. Mean FPD life span by selected variables
bridges) according to selected variables
No. of Mean
No. of % Parameter units life span P
Parameter units Failure P-value
Gender
Gender Male 76 6Æ24 NS
Male 76 5Æ3 0Æ47 Female 104 6Æ38 0Æ001
Female 104 6Æ7 Age
Age )40 21 4Æ29
)40 21 19 0Æ07 41–50 35 6Æ42
41–50 45 4Æ4 51–60 65 5Æ17
51–60 65 4Æ6 61+ 55 8Æ63
61+ 49 4Æ1 No. of units in FPD
No. of units in FPD 1 50 5Æ92 NS
1 50 8Æ0 0Æ37 2–4 81 6Æ32
2–4 81 7Æ4 5–7 49 6Æ73
5–7 49 2Æ0 Plaque index
Life span of FPD in years 0–1Æ0 160 3Æ56 NS
1–5 103 6Æ8 0Æ73 1Æ1+ 20 7Æ89
6–10 51 3Æ9 Upper ⁄ lower jaw
11+ 26 7Æ7 Upper 107 5Æ62 0Æ01
Plaque index Lower 73 7Æ36
0–1Æ0 160 6Æ0 0Æ65 Right ⁄ left
1Æ1+ 20 5Æ0 Right 104 6Æ24 NS
Upper ⁄ lower jaw Left 76 6Æ43
Upper 107 4Æ7 0Æ25 Vital tooth ⁄ root canal treatment
Lower 73 8Æ2 Vital 73 6Æ88 NS
Right ⁄ left Root canal treatment 107 5Æ94
Right 104 7Æ7 0Æ24 Post and core
Left 76 3Æ9 Immediate 43 6Æ39 0Æ05
Root canal treatment ⁄ vital tooth Cast 58 5Æ15
Vital 73 1Æ4 0Æ02 No post and core 79 7Æ14 NS
Root canal treatment 107 9Æ3 No. of crowns in FPD
Post and core 1–2 95 6Æ74
Immediate 43 7 0Æ49 3+ 85 5Æ86
Cast 58 8Æ6 Restorative material
No post and core 79 3Æ8 PFM 161 5Æ55 0Æ01
No. of crowns in FPD Veneered acrylic 13 16Æ3
1–2 95 7Æ4 0Æ46 Veneered porcelain 4 5Æ75
3+ 85 4Æ7 Metal crown 2 5Æ00
Restorative material Periapical lesions
PFM 161 6Æ8 0Æ71 Yes 4 6Æ29 NS
Veneered acryl 13 0 No 176 7Æ50
Veneered porcelain 4 0
Metal crown 2 0
retention, and the distribution and vitality of the
Periapical lesions
Yes 4 0 0Æ78
abutment teeth.
No 176 6Æ3 In our study, 50 FPDs (bridges) were examined. The
largest group (40%) consisted of 3-unit FPDs, and
3- and 4-unit FPDs accounted for 66%, which is
This seems to suggest that more attention should be consistent with several other studies carried out in dental
directed toward the identification of high-risk caries school clinics (Silness, 1970; Valderhaug & Karlsen,
patients and limiting caries-promoting factors, such as 1976; Leempoel et al., 1985; Valderhaug, 1991; Leem-
special diet and caries-preventive measures. poel et al., 1995; Al Rafee & Fayyad, 1996c). Generally,
Several reasons might underlie the observed differ- our students carried out 3-to-4 unit FPDs and do not take
ences in survival rates, including observation time, FPD on cases with periodontal involvement.

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 165–170

 EVALUATION OF FIXED PARTIAL DENTURES 169

The average life span of FPDs in this study was FOSTER, L.V. (1991) The relationship between failure and design in
6Æ3 years, with a 6% failure rate (Table 3 and Fig. 1). conventional bridgework from general dental practice. Journal
of Oral Rehabilitation, 18, 491.
The latter is in agreement with some studies (Roberts,
GLANTZ, P.O., JENDERSEN, M.D., RYGE, G. & NILNER, K. (1984)
1970b; Karlsson, 1989; Scurria, Bader & Shugars, Quality of fixed prosthodontics after 15 years. Journal of
1998), but others reported 10 and 17% (Karlsson, Prosthetic Dentistry, 52, 475.
1986; Palmqvist & Soderfeldt, 1994; Leempoel et al., GLANTZ, P.O., NILNER, K., JENDERSEN, M.D. & SUNDBERG, H. (1993)
1995; Libby et al., 1997). Our study gave no indication Quality of fixed prosthodontics after 15 years. Acta Odontologica
of the real life span of the FPDs since most of them were Scandinavica, 51, 247.
KARLSSON, S. (1986) A clinical evaluation of fixed bridges, 10 years
in good condition and functional when we examined
following insertion. Journal of Oral Rehabilitation, 13, 423.
them. Other studies reported a range of life spans, from KARLSSON, S. (1989) Failures and length of service in fixed
2 to 11 years (Roberts, 1970a, b; Schwartz et al., 1970; prosthodontics after long-term function. A longitudinal clinical
Valderhaug & Karlsen, 1976; Reuter & Brose, 1984; study. Swedish Dental Journal, 13, 189.
Walton et al., 1986; Odman & Karlsson, 1988; Cheung LEEMPOEL, P.J., ESCHEN, S., DE HAAN, A.F. & VAN’T HOF, M.A. (1985)
An evaluation of crowns and bridges in a general dental
et al., 1990; Foster, 1990; Leempoel et al., 1995; Al Rafee
practice. Journal of Oral Rehabilitation, 12, 515.
& Fayyad, 1996b). LEEMPOEL, P.J., KAYSER, A.F., VAN ROSSUM, G.M. & VAN’T HOF, M.A.
The negative influence of non-vital teeth shown in (1995) The survival rate of bridges. A study of 1674 bridges in
other studies was confirmed in our research (Table 3) 40 Dutch general practices. Journal of Oral Rehabilitation, 22,
(Leempoel et al., 1995). Non-vital abutments tend to 327.
LIBBY, G., ARCURI, M.R., LAVELLES, W.E. & HEBL, L. (1997) Longevity
decrease survival rates. The presence of posts and cores
of fixed partial dentures. Journal of Prosthetic Dentistry, 78, 127.
may be another cause of failure. In our study, PFM was
ODMAN, P.A. & KARLSSON, S. (1988) Follow up study of patients
the material most commonly used for FPD construction. with bridge construction performed by private dental surgeons
Only 13 crowns were gold-veneered acrylic, and they and at a University clinic, 8 years following insertion. Journal of
were long lasting than the others. Oral Rehabilitation, 15, 55.
It should be stressed that these differences were PALMQVIST, S. & SODERFELDT, B. (1994) Multivariate analyses of
factors influencing the longevity FPD retainers and abutments.
highly significant. Another study reported a more than
Journal of Prosthetic Dentistry, 71, 245.
two-fold mean life span of gold-based bridges, as RANDOW, K., GLANTZ, P.O. & ZOGER, B. (1986) Technical failure and
compared with PFM ones (Foster, 1990). some related clinical complications in extensive fixed prostho-
In our opinion, the functional lifetime of the crown is dontics (1986). An epidemiological study of long-term clinical
the decisive criterion for treatment aimed at increasing quality. Acta Odontologica Scandinavica, 44, 241.
REUTER, J.E. & BROSE, M.O. (1984) Failures in full crown retained
the functional lifetime of the natural dentition.
dental bridges. British Dental Journal, 157, 61.
ROBERTS, D.H. (1970a) The failure of retainers in bridge prostheses.
References An analysis of 2000 retainers. British Dental Journal, 128, 117.
ROBERTS, D.H. (1970b) The relationship between age and failure
AL RAFEE, M.A. & FAYYAD, M.A. (1996a) Failure of dental bridges I: rate of bridge prostheses. British Dental Journal, 128, 175.
age and sex of patients and distribution of replaced and SCHWARTZ, N.L., WHITSETT, L.D., BERRY, T.G. & STEWART, J.L. (1970)
abutment teeth. Journal of Oral Rehabilitation, 23, 280. Unserviceable crowns and fixed partial dentures: life-span
AL RAFEE, M.A. & FAYYAD, M.A. (1996b) Failure of dental bridges causes for loss of serviceability. Journal of the American Dental
II. Prevalence of failure and its relation to place of construction. Association, 81, 1395.
Journal of Oral Rehabilitation, 23, 438. SCURRIA, M.S., BADER, J.D. & SHUGARS, D.A. (1998) Meta-analysis of
AL RAFEE, M.A. & FAYYAD, M.A. (1996c) Failure of dental bridges fixed partial denture survival: prostheses and abutments.
III. Effect of some technical factors. Journal of Oral Rehabilitation, Journal of Prosthetic Dentistry, 79, 459.
23, 675. SILNESS, J. (1970) Distribution of artificial crowns and fixed partial
CHEUNG, G.S., DIMMER, A. & MELLOR & GALE, M. (1990) A clinical dentures. Journal of Prosthetic Dentistry, 23, 641.
evaluation of conventional bridgework. Journal of Oral Rehabil- SILNESS, J. & LÖE, H. (1964) Periodontal disease during pregnancy.
itation, 17, 131. II. Correlation between oral hygiene and periodontal condition.
FAYYAD, M.A. & AL RAFEE, M.A. (1997) Failure of dental bridges IV: Acta Odontologica Scandinavica, 22, 121.
Effect of supporting periodontal ligament. Journal of Oral VALDERHAUG, J. (1991) A 15 year evaluation of fixed prosthodon-
Rehabilitation, 21, 401. tics. Acta Odontologica Scandinavica, 49, 35.
FOSTER, L.V. (1990) Failed conventional bridge work from general VALDERHAUG, J. & KARLSEN, K. (1976) Frequency and location of
practice: clinical aspects and treatment needs of 142 cases artificial crowns and fixed partial dentures constructed at a
(Review). British Dental Journal, 168, 199. dental school. Journal of Oral Rehabilitation, 3, 75.

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 165–170

170 N . H O C H M A N et al.

WALTON, J.N., GARDNER, F.M. & AGAR, J.R. (1986) A survey Correspondence: M. Zalkind, Department of Prosthodontics, Hebrew
of crown and fixed partial denture failures: length of service University-Hadassah School of Dental Medicine, POB 12272, 91120
and reasons for replacement. Journal of Prosthetic Dentistry, 56, Jerusalem, Israel.
416. E-mail: zalkind@cc.hji.ac.il

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 165–170