Crown & Bridge Prosthodontics

Lecture 4 Dr. Lamis A. Al-Taee

Biomechanical Considerations of Fixed Partial Denture

Management of the destructive forces

- The design of the bridge must handle the occlusal & dislodging forces
such as torque, flexure and tension.
- Occlusion must be designed to optimize the distribution of occlusal forces
evenly throughout the envelope of motion over the entire mouth.
The biomechanical considerations include the role of span dimension, pontics’
characteristics, the connecters or joints of the prosthesis, abutment tooth &
acting forces (masticatory) on the success of the constructed bridge.

Span length

The distance between abutments that affects the feasibility of placing FPDs.

- One missing tooth is ideal for replacements.

- 2-3 adjacent teeth requires careful evaluation of other factors (crown-root
ratio, root length & form, periodontal health, mobility, occlusal force &
biomechanical factor).

The dimensions of the span (MD length and OG height) affect the number of
the selected abutments, type of retainers & materials that are used for bridges’
construction. In addition to the increased load placed on the periodontal
ligament by long span FPDs, longer spans are less rigid. All FPDs flex slightly
when subjected to a load, the longer the span the greater the flexing. Bending
or deflection varies directly with the cube of the length & inversely with the cube
of the occlusogingival thickness of the pontic.

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Length of the span (Law of beam)

It is an engineering principle states that as the length of the span increases,

the flexure of a system will be the increase in length to the power of three
(cubed)

Compared with a FPD having a single-tooth pontic span, a two-tooth pontic span will bend
8 times as much. A three-tooth pontic span will bend 27 times as much as a single pontic.

This mean replacing three missing posterior teeth with FPDs rarely has
favourable prognosis, especially in the mandibular arch (Treatment with RPDs
or implant supported prosthesis).

Height of the connector (Law of beam)

As the height of the span decreases, the flexure of a system will be the increase
in length to the power of three (cubed). Therefore, halving the connector height
would yield 8 times the flexure.

A pontic with a given occluso-gingival dimension will bend 8 times as much if the pontic
thickness is halved.

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Therefore, a long span FPD on short mandibular teeth can have disappointing
results. Excessive flexing under occlusal loads may lead to failure of the long
span FPDs (fracture of the porcelain veneer, connector breakage, retainer
loosening and caries, or unfavourable tooth or tissue response).

To minimise flexing:

- Select pontic design with greater occlusogingival dimension

- Pontics & connectors should be made as bulk as possible to ensure
optimum rigidity without jeopardizing gingival health.
- Long span or unfavourable crown/root ratio then used double abutments
to enhance the retention & support the long span FPD.

Double abutment

It refers to the use of two adjacent abutment teeth at one or both ends of a FPD

Indications

- To increase the retention of the

restoration
- To increase area of supporting
periodontal ligament and bone.
- Un favourable crown-root ratio

- Long span FPDs

- Splint & stabilise periodontally compromised teeth.

Criteria for double abutment

- Secondary abutments must have as much root surface area & a

favourable crown root ratio as the primary abutment.
- The retainers on secondary abutment must be at least as retentive as on
primary abutments because when the pontic flexes, tensile forces will be
applied on the retainers of the secondary abutments.

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Arch curvature:

When pontics lie outside the interabutment line, they

act as a lever arm, which can produce a torqueing
movement.

- This is a common problem in replacing all four

maxillary incisors with a FPD.
- It is more pronounced in pointed taper arch
anteriorly. The more the taper of the arch, the longer will be the lever arm,
the more stress or torqueing force, while the more circular arch curvature
reduces such a problem.

To solve such problem and offset the torque, additional retention is obtained in
the opposite direction from the lever arm & at distance from the inter abutment
axis equal to the length of lever arm, this mean, that two abutment teeth at
each end of long span anterior FPD must be used in order to resist this
tipping forces. This mean first premolars are used as secondary abutments for
a maxillary four pontic canine-to-canine FPD.

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Pier (intermediate) abutment:

It is a natural tooth located between terminal abutments that

serve to support fixed or removable prosthesis. Because it
lies in the middle of the span, it creates huge stresses on the
terminal abutments and acts as a fulcrum causing failure of
the weaker retainer. These forces loosen the retainer or the
casting, or may lead to leakage around the margin leading to
extensive caries.

To overcome such complication, you can select one of the following

approaches:

1) The use of extremely retentive retainers.

2) When periodontal support is adequate, a much
simpler approach would be to cantilever one
segment of the bridge on one side of pier
abutment.

3) Use of non-rigid connector.

- It is a broken stress mechanical union of retainer

(dovetail keyway) & pontic (T- shaped way)
- It transfers shear stress to supporting bone rather
than the connectors.
- It appears to minimize mesiodistal torquing of the
abutment, while permitting them to move
independently.
- The most commonly used non-rigid design T- shaped key that is attached
to the pontic & a dovetail keyway placed in the retainer

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Location of the key & key way:

- Keyway should be placed within the distal contours of pier abutment.

- Key should be placed on the mesial side of the distal pontic.

Why keyway should be placed on the distal not on mesial of pier

abutment?

Long axes of posterior teeth usually lean slightly in a mesial direction and tilt
more mesially when subjected to occlusal forces. Therefore, if keyway is
placed on the distal of pier abutment, then the mesial movement seats the key
into the keyway more solidly. If placement of the keyway is on the mesial side
then it causes the key to be unseated during the mesial movement which in
time can cause a pathologic mobility in the canine or failure of the canine
retainer.

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Tilted molar abutment: Mesially tilted second molars

The early loss of mandibular 1st molar due caries is still relatively common. If
this space is ignored, the 2nd molar will tilt mesially with the eruption of 3rd molar
which inturn might be drifted & tilted with the 2nd molar. Then it becomes difficult
to make a satisfactory FPD, due to the positional relationship no longer allows
for parallel path of insertion without interferences from adjacent teeth, added
to the excessive preparation that is needed.

To solve this problem:

1- Ortho treatment (Uprighting the tilted tooth)

If the tilting is severe, uprighting of the molar is

indicated by orthodontic treatment. This helps in
distributing the occlusal forces & eliminating the
bony defects along the mesial surface of the
root. In such case the 3rd molars, if present, are
better to be extracted to facilitate movement of
2nd molar (Average treatment time 3 months).

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2- Using proximal hall partial crown as a retainer on tilted molar abutment

Proximal half-crowns can be used as a retainer on distal abutment. This is

simply a three-quarter crown that has been rotated 90 degrees so that the
distal surface is uncovered. It is possible only if:
- The distal surface is caries free.
- The distal surface is not decalcified.
- There is a very low incidence of proximal caries throughout the mouth.
- The patient is able to keep the area exceptionally clean.
- If there is a Severe Marginal Ridge Height Discrepancy between the
distal of the 2nd molar & the mesial of the 3rd molar the proximal-half
crown is contraindicated

3- Using telescope crown & copping as retainer.

A telescope crown & coping can be used as a

retainer on the distal abutment

i.e. Full crown preparation with heavy reduction

is made to follow the long axis of tilted molar.
An inner coping is made to fit the tooth
preparation and a proximal half-crown that will
serve as a retainer for the FPD is fitted over the
coping.

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Advantages: it allows total coverage of the clinical crown while compensating
for the discrepancy between the path of insertion of the abutments.

4- Non rigid connector is another solution to the problem.

The connection of fixed bridges in some manner that will allow the various
components of the prothesis to be seated separately

A full preparation is done on the molar with its

path of insertion parallel with the long axis of
the tilted tooth. A box form is placed on the
distal surface of the premolar to
accommodate a keyway in the distal aspect
of the premolar. Reasons for NOT placing the
non-rigid connector on the mesial aspect of
the tipped molar is that it can lead to greater
tipping of the tooth.

It is indicated when the molar exhibits marked lingual as well as mesial

inclination because the routine FPD in such cases will lead to drastically
overtapered preparation with no retention.

Because telescope crowns and non-rigid connectors both require tooth

preparations that are more destructive than normal, the selection of one of
these would be influenced by the nature of previous destruction of the
prospective abutment tooth for ex. the presence of a dowel core or a DO
amalgam on the premolar would favour placement of a non-rigid connector,
while extensive facial and / or lingual restorations on the tilted molar would call
for the use of a telescope crown.

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Canine replacement fixed partial denture

FPDs replacing canines can be difficult because the

canine often lies outside the interabutment axis.

The prospective abutments are the lateral incisor

usually the weakest tooth in the entire arch, & the 1st
premolar, the weakest posterior tooth.

A FPD replacing maxillary canine is subjected to more stress

than that replacing a mandibular canine since forces are
transmitted outward (labially) on the maxillary arch, against
the inside of the curve (its weakest point) & the pontic lies
farther outside the inter-abutment line axis.

While, in mandibular canine, the forces are directed inward

(lingually), against the outside of the curve (its strongest
point), & the pontic is closer to the inter-abutment axis.

So in cases of canine replacement FPD, you should consider the following

points:

- Any canine replacement FPD must be considered a complex

- No FPD replacing a canine should replace more than one additional tooth
(the support from secondary abutments will have to be considered).
- An edentulous space created by the loss of a canine and any two
contiguous teeth is best restored with Implants or a RPD.

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Evaluation of the path of insertion

- Path of insertion should be check before imprint.

- Parallelometer-mirror can easily spot the positional relationship of the
prepared abutments, especially in difficult case or inexperience dentist.

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