Resin bonded bridges.modi/ Labial orthodontics
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Resin bonded bridges.modi/ Labial orthodontics
- 1. 1 Resin Bonded Fixed Partial Denture –case reports. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
- 2. 2 Introduction • The need for conservation of natural tooth structure has always been the desired but elusive goal in dentistry. • In fixed partial prosthodontics this goal manifests itself with the continued interest and development of Resin bonded fixed partial dentures (RBFPD). www.indiandentalacademy.com
- 3. 3 Definition • Resin bonded prosthesis A prosthesis that is luted to tooth structure,primarily enamel,which has been etched to provide mechanical retention for the resin cement. -GPT-7 • Also called as Maryland bridges, Rochette bridges. www.indiandentalacademy.com
- 5. 5 Why a Re-Look ? 1. Sometimes Cost and other constraints make single teeth implants unfeasible. 2. Recent and further scope of Advances in adhesive dentistry. 3. Lesser failure rates of RBFPD’s found in recent studies. www.indiandentalacademy.com
- 6. 6 History and development • Development of Acid etching of enamel by Buonocore. • Bowen developed the BIS-GMA composite resins. www.indiandentalacademy.com
- 7. 7 Rochette bridge • Developed in 1973. It was a complete innovation. Use of ring like retainers,with funnel shaped perforations through them to enhance resin retention. Silane coupling agent was used to produce adhesion to the metal. www.indiandentalacademy.com
- 8. 8 Maryland ridge • Etched metal surface first developed by Livaditis and Thompson. • Treatment of metal surface with acids and controlled electric current. www.indiandentalacademy.com
- 9. 9 Virginia bridge. • Roughned surface of the retainer itself provides for retention • Achieved by lost salt technique. • Air abrasion with aluminium oxide. www.indiandentalacademy.com
- 10. 10 Advantages of Resin bonded bridges. 1) Reduced cost . 2) No anesthetic needed. 3) Supragingival margins. 4) Minimal tooth preparation. 5) Rebonding possible. www.indiandentalacademy.com
- 11. 11 Indications. 1) Adolescents with single missing teeth (traumatic or congenital). 2) Caries- free abutment teeth and good oral hygiene. 3) Maxillary incisor replacements (most favourble prognosis) and Mandibular incisor replacements. 4) Periodontal splints. 5) Single posterior tooth replacements. www.indiandentalacademy.com
- 12. 12 • Survival rates of FPD – 96% at 5 years – 74% at 15 years • Creugers et al 1994. • Survival rates of RBFPD – 74% at 4 years (meta study) – 93% at 11 years Barrack www.indiandentalacademy.com
- 13. 13 Tooth preparation The strength of bonding to prepared and etched enamel is greater than that to etched but unprepared enamel.(Aker et al 1979) Preparation should cover as large as area as esthetically possible www.indiandentalacademy.com
- 14. 14 Cervical margin should always be in enamel and Supragingival. Preparation should ensure precise insertion and seating of the framework. 180 0 wraparound of the metal. www.indiandentalacademy.com
- 16. 16 Examination • Root exposure of central incisor and canine. • Widened edentulous space mesiodistally. • I mm over jet and overbite www.indiandentalacademy.com
- 17. 17 • Good oral hygiene and favorable periodontal status. • Study models were made and articulated. • Radiographs were taken. www.indiandentalacademy.com
- 18. 18 Treatment plan • Resin bonded fixed partial denture was the treatment of choice 1. As it kept the option of going for bone grafting and implant a possibility. 2. Angulation of abutments and gingival recession made the possibility of 3 unit conventional FPD a difficult proposition. www.indiandentalacademy.com
- 19. 19 Tooth preparation • Very conservative palatal preparation. • Supragingival chamfer. • Proximal groves. www.indiandentalacademy.com
- 20. 20 Laboratory procedure • Wax pattern was made and casted in Ni-Cr alloy. • Pontic was made in appropriate shade of ceramic. • Holes were made on the wings to facilitate light curing of composite. www.indiandentalacademy.com
- 21. 21 Bonding steps. • Sand blasting of metal framework. • Acid etching • Rinsing and drying. • Contamination to be avoided at all cost. www.indiandentalacademy.com
- 29. 29 • Bone loss and gingival recession in abutment teeth. • Grade 1 mobility. www.indiandentalacademy.com
- 30. 30 Treatment plan. • Resin bonded fixed partial denture was the treatment of choice. As patient wanted a fixed replacement of the missing teeth. Need for splinting the lower anteriors. www.indiandentalacademy.com
- 32. 32 • Conventional Maryland bridge fabricated with porcelain fused to metal pontic. www.indiandentalacademy.com
- 33. 33 • Bonded with resin cement. www.indiandentalacademy.com
- 36. 36 Case 3 • 16 year old female patient. • Traumatic loss of maxillary left central incisors . • Using RPD for 3 years. www.indiandentalacademy.com
- 37. 37 • Ridge resorption. • Widened pontic space. www.indiandentalacademy.com
- 38. 38 Treatment plan Resin bonded bridge was the treatment of choice. • Taking into consideration age of the patient. • Need for the conservative treatment. www.indiandentalacademy.com
- 40. 40 Case –4 Metal free resin bonded bridge • Loss due to trauma. • Highly reduced pontic space. www.indiandentalacademy.com
- 41. 41 Treatment plan. Metal free resin bonded bridge was the treatment of choice • As patient had edge to edge bite - less unfavourable stresses transmitted to the prosthesis. • Superior esthetics. www.indiandentalacademy.com
- 42. 42 Treatment plan • Proximal slicing of the abutments was done to distribute the space evenly. • Diagnostic wax up was shown to the patient www.indiandentalacademy.com
- 45. 45 Laboratory procedures • Hardcore porcelain fired on refractory cast.(Hi – ceram) • Porcealin build up done on the coping . www.indiandentalacademy.com
- 50. 50 Disadvantages • Irreversible. • Uncertain longevity. • No space correction. • No alignment correction. • Difficult temporization. www.indiandentalacademy.com
- 51. 51 Contraindications. • Extensive caries. • Nickel sensitivity. • Deep vertical overbite. • Extensive restoration on abutment teeth. • Parafuncitonal habits www.indiandentalacademy.com
- 52. 52 Conclusion • Rapid development in adhesive technology holds a promising future for RBFPDs, which were originally developed as an interim restoration. Today high success rate and reducing cost is fast making RBFPD’s as a treatment alternative for permanent oral rehabilitation. www.indiandentalacademy.com
- 53. 53 • Furthermore in a developing country like India this esthetic approach, which is cost effective too, holds promising future. www.indiandentalacademy.com
Notas del editor
- Good evening Respected chairperson,senior members of the profession and my dear collegues and friends. Presented before you today are 4 case reports and the rationale for the treatment with resin bonded fixed partial denture.
- conservation of natural tooth structure has always been the desired but elusive goal in dentistry. In fixed partial prosthodontics this goal manifests itself with the continued interest and development of resin bonded fixed partial dentures (RBFPD).
- By defination a resin bonded prosthesis is A prosthesis that is luted to tooth structure,primarily enamel,which has been etched to provide mechanical retention for the resin cement. - Also called as Maryland bridges, Rochette bridges
- Resin bonded fixed partial dentures have been in our profession for 3 decades now. So why it needs a relook after 30 years of its introduction. Resin bonded fixed partial dentures have been in our profession for 3 decades now so why it needs a re-look after 30 years of its introduction. There are 3 resons for this renewed interest Sometimes Cost and other constraints make single teeth implants unfeasible. Recent and further scope of Advances in adhesive dentistry. Lesser failure rates of RBFPD’s found in recent studies.
- RBFPD’s has its roots in development of acid etching by bunocore and BIS-GMA composite by Bowen. Ibsen first described the attachment of an acrylic resin pontic to an unprepared tooth using a composite bonding resin.
- There are different types of resin bonded bridges.one of the commonest is rochette bridge.it was a complete innovation at the time. Use of ring like retainers,with funnel shaped perforations through them to enhance resin retention. Silane coupling agent was used to produce adhesion to the metal
- Another type of bridge is maryland bridge developed by livaditis and thompson. Metal surface treated with electric current and acids helps in retention.
- In virginia bridge the roughened surface of retainer itself provides for retention. Achieved by lost salt technique or Air abrasion with aluminium oxide.
- Advantages of Resin bonded bridges as compared to conventional FPD. But it is not as significant as first thought,as more of dentist’s time and skill are required. No anesthesis is required as most of the preperation is in enamel. Supragingival margin therefore easy impression technique ad less patient discomfort. Conservation of tooth structure. Rebonding of retainers is possible.
- This 26 year female patient reports to dept of prosthodontics ragas dental college,cheenai for the replacement of congentially missing left lateral incisor. History: patient has congentally cleft palate for which she was operated at age of …… The defect was closed with the flap raised from the tongue as seen here .
- The patietn had undergone extensive orthodontic treatment for the alignment of collapsed dentition. There is a bone defect on which in relation to missinglateral incisor where bone grafting was attempted for an implant placement . Patient was higly motivated and wanted conservative esthitic treatment for her problem.
- Sand blasting of metal framework. Acid etching: it increases the surface energy of the enamel,thereby improving its wetability and spreadibility of bonding agents. Rinsing and drying. Contamination to be avoided at all cost.
- due to Periodontitis a 55year old patient.patient wants fixed replacement of the missing teeth.
- Resin bonded fixed partial denture was the treatment of choice. As patient wanted a fixed replacement of the missing teeth. Need for splinting the lower anteriors.
- Conservative tooth preparation with finish line above cemento-enamel junction.
- Conventional Maryland bridge fabricated with porcelain fused to metal pontic.
- Bonded with resin cement.
- Prosthesis with elongated pontic to cover the bone loss on the ridge and also acting as a splint.
- Lingual view
- 16 year old female patient. Traumatic loss of maxillary left central incisors . Using RPD for 3 years.
- On examination , Ridge resorption. Widened pontic space.
- Resin bonded bridge was the treatment of choice. Taking into consideration age of the patient. Need for the conservative treatment.
- A conventional rochette bridge was fabricated and luted with resin cement.
- Patient gave the History of trauma. Highly reduced pontic space. Patient was wearing an RPD for some time and was not happy with the esthetics due to the reduced ponitc space.
- Proximal slicing of the abutments was done to distribute the space evenly. Diagnostic wax up was shown to the patient
- We3 can appreciate the difference in pontic space in this slide.
- It was done with spot etching of enamel and then bonding with comosite to facilitate easy removal.