Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Factors Influencing Abutment Selection in Fixed

Partial Denture-A Review
Authors: Shajahan P.A 1, Rohit Raghavan 2, Shilpa R.S 3.
 Professor, Department of Prosthodontics, Royal Dental College, Palakkad, Kerala.
 Professor and Head, Department of Prosthodontics, Royal Dental College, Palakkad, Kerala.
 Post Graduate Student, Department of Prosthodontics, Royal Dental College, Palakkad, Kerala.

Abstract:- Abutment selection for fixed partial denture is and the occlusion with the opposing teeth can be easily
an important criterion for the success and longevity of the visualized.3, 4
prosthesis. The forces acting on the prosthesis are
dissipated along the abutments to the periodontal III. RADIOGRAPHIC EXAMINATION
ligament. The major cause of failure includes
inappropriate designing, taking improper materials for Periapical and bitewing radiographs are very important
fabrication, insufficient tooth preparation, and not having in selection of the abutment teeth. Panoramic radiographs are
enough knowledge regarding the biomechanics. very relevant for patients having temporomandibular joint
Abutment selection for fixed partial dentures involves dysfunction.5
proper diagnostic ability and in-depth knowledge about
the stomatognathic system. This article review about the An intraoral radiographic examination interprets:
diagnostic aspect and the factors influencing the  Bone support.
abutment selection for a fixed partial denture, which aids  Number of the root and root anatomy (long, short,
in the long term success of the prosthesis. slender, broad, bifurcated, fused, dilacerated etc.) and
rootproximity.5
Keywords:- Abutment, Crown Root Ratio, Fixed Partial  Supporting bone quality, trabecular patterns and
Denture, Occlusal Anatomy, Surface Area, Periodontium. reactions to the functional changes.
 Periodontal ligament spaces and evidence of Trauma
I. INTRODUCTION from occlusion.
 Areas of vertical and horizontal bone resorption and
Majority of the patients prefer fixed partial denture as a furcation involvement.
treatment modality for the rehabilitation of missing teeth.  Degree of the parallelism of the abutment teeth.
Fixed partial denture usually utilizes an abutment tooth on each
 Continuity and integrity of lamina dura.
terminal of the edentulous spaces which is needed to supportthe
 Morphology of the pulp and root canal treatment done
prosthesis.1Abutments bear the load of mastication and the
previously with or without post and cores.
choice of abutment determines the success of the prosthesis.
 Evidence of any apical pathology, root resorption or root
Failure of the prosthesis occurs due to poor engineering, the
use of inappropriate materials for fabrication, insufficient fractures.
tooth preparation, and defective manufacturing. Among this  Retained root fragments, areas of radiolucency,
the major concern of dentists is the abutment selection. calcifications, existing foreign bodies or impacted teeth.
Meticulous awareness about the anatomy, ceramics, the  Presence of carious lesions, the condition of restorations
chemistry and physics of dental materials, metallurgy, in the oral cavity, and vicinity of carious lesion to the pulp.
Periodontics, phonetics, physiology, radiology and the  Degree of closeness of carious lesions and restorations
mechanics of oral function is very indispensable for the towards the alveolar crest.
success of the prosthesis.2 Proper diagnosis and treatment  Deposits of calculus.5
planning are the first and foremost step which determines the
longevity of the fixed partial denture. This article discusses IV. FACTORS WHICH INFLUENCES THE
about few diagnostic procedures and factors to be considered ABUTMENT SELECTION
in the selection of abutments for a fixed partial denture.
The preference of the abutments for fixed prosthesis are
II. DIAGNOSTIC CASTS decided by a combination of load-withstanding capacity of
the supporting teeth along with the forces and stresses to
Diagnostics casts must be properly oriented to the which they are exposed. The factors like root number, shape,
transverse hinge axis and to the plane of occlusion on an length, alignment, and remaining bone height is directly
articulator and resembles the eccentric movements in the oral proportional to the load- bearing capacity of the abutment
cavity. This articulation procedure provides a simple teeth. Therefore, certain factors have to be considered before
evaluation and correlation of occlusal relationship of both taking the teeth as an abutment.
dental arches and the abutment teeth. Rotated teeth can be
easily identified. The shape and position of the abutment teeth

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Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The factors influencing abutment selection are as withstand the additional forces in a better manner. Jepsen in 1963
follows: has reported the root surface areas of the various teeth
 Crown to root ratio
 Surface area Root Surface Area
 Arch form (mm2) Maxillary Mandibular
 Rigidity 1. Central Incisor 204 (10%) 154(8%)
 Margin location 2. Lateral Incisor 179(9%) 168(9%)
 Occlusal anatomy 3. Canine 273(14%) 268(15%)
 Buccolingual dimension of teeth 4. I Premolar 234(12%) 180(10%)
 Pontic tissue contact
5. II Premolar 220(11%) 207(11%)
 Crown length
6. I Molar 433(22%) 431(24%)
 Crown form
 Degree of mutilation of crown 7. II Molar 431(22%) 426(23%)
 Root configuration
 Root proximity According to this law, if there is a single missing teeth
 Alveolar ridge form it can be successfully rehabilitated by considering two
 Span length adjacent abutments for support. If twoteeth are missing, they
 Mobility can be replaced by taking two teeth as abutment for support,
 Phonetics but the limit is being reached.
 Esthetics
 Age of patient Nyman and Ericsson, however, raised a doubt on the
 Psychology validity of Ante’s law. They proved their statement by
 Prognosis showing that teeth with reduced bone support can also be
considered as abutments. Among the various cases discussed
 Crown Root Ratio (CRR) by them, there was no evidence of attachment loss over a
According to GPT 9 "the physical relationship between period of 8 to 11 years even if the abutment root surface area
the portions of the tooth not within the alveolar bone, as was lesser than half that of the replaced teeth. Nyman and
determined by a radiograph, compared with the portion of the Ericsson claimed that the reason behind this observation
tooth within alveolar bone". As the alveolar bone level could be by the meticulous root planning done in the active
migrates apically, the lever arm of that portion out of the bone phase of the treatment. They also added that proper plaque
increases, and that can increase the occurrence of deleterious control in the course of observed period and proper designing
lateral forces acting on it. The optimum crown- root ratio for of the occlusal aspect of the prosthesis was also important. 8
the abutment tooth is 2:3. The minimum acceptable ratio for
an abutment under normal situations (such as numberof teeth  Long axis relationship
being replaced, tooth mobility and overall periodontal health The long axis relationship of the abutment teeth should
is good) is considered to be 1:1. Even though there are certain not be more than 25˚ to 30˚from parallel. The architectureofthe
conditions where a crown root ratio greater than 1:1 might be periodontal ligament is built in such a way that it can
acceptable. A 1:2 crown to root ratio is considered to be withstand the forces in a better way when they are transmitted
ideal.1 As the crown to root ratio is purely based on linear through the long axis of the abutment teeth. A critically
measurement values, the clinician should also consider other inclined tooth will not bear the stresses much when compared
factors like the alveolar bone height and the total supported to an abutment which is moreover erect. The lesser the force
root surface of the abutment tooth.3 Dykema, proposed a and the shorter the edentulous span, the more a tooth may be
1:1.5 as an acceptable CRR for abutments. Although the inclined and still be considered as an abutment.5
authors dictated that this CRR ratio may be acceptable only in
cases where the periodontium is inahealthy condition, and the  Arch form
occlusion is manageable.6 When the edentulous span is longer Curvature of arch induces stress in FPD. Pontic outside
and the forces acting on the abutment teeth are greater, the the inter abutment axis induces torquing movement. Teethin
more favorable the crown-to-root ratio must be. The CRR can different quadrants of the arch move in different directions.
be compensated in conditions where multiple teeth are taken Because of the curvature of the arch, the faciolingual
as abutment teeth.3, 7 movement of the anterior tooth takes place at a considerable
angle to the faciolingual movement of the molar.9 FPDs
 Periodontal surface area comprising the anterior teeth are set in the shape of an arc.
ANTE’s LAW (1971) was introduced by Ante (1926) Whenever a force is applied on the pontics,a rotational effect
and later proposed by Johnston, Dykema, Shillinburg, will take place in the abutments, and a vertical force is exerted
Tylman. The combined pericemental area of the abutment on the terminal ends of the fixed partial denture. The lever
teeth should be equal to or greater to the pericemental area arm can be assessed by drawing a line perpendicular from the
than the teeth to be replaced (Ante’s Law). Multiple teeth fulcrum line to the point on the farthest located pontics from
abutment are indicated in situations where there is insufficient this line. The fulcrum line is determined by drawing a line
periodontal surface area, along with that other biomechanical joining the abutmentsadjacent to the edentulous space at the
factors has to be considered. Teeth having more surface area can proximo-occlusal angles of the preparation.10There will be
more leverage in cases where the four maxillary incisors are

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Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
replaced in a narrow-tapered arch. The lever arm is shortened  Crown length
by the existence of a single incisor. By using additional Inorder to provide adequate retention, the abutment teeth
abutments, a long lever arm can be equalized. For a maxillary should have adequate length. Additional abutments are
four pontic canine to the canine fixed partial denture, required for pontics having increases occlusogingival height.
sometimes first premolars are taken as secondary abutments. Splinting of the multiple abutments should be done inorder to
They exhibit excellent retention due to the tensile forces obtain support for the teeth having crown height <4 mm.
exerted to the premolar retainers.10
 Crown Form
 Rigidity To enhance retentive and esthetic qualities full coverage
Lack of rigidity of the prosthesis is one of the common causes retainers are essential for teeth having tapered crown form as
of failure. Utilizing the right materials which are arranged in it will interferes with parallelism of the preparation. Egs:
the exact shape, form and thickness with respect to the anterior teeth with poorly developed cingula and short
stresses acting upon them may aid in sufficient rigidity to the proximal walls and mandibular premolars with lack of well-
prosthesis. Flexure results in damage to the abutments and it developed lingual cusps and short proximal surfaces. Partial
may lead to eventual loosening of the retainers, and fatigue of coverage retainers are esthetically unacceptable for incisors
the metal. The stresses produced should not overcome the yield having very thin highly translucent incisal edges.5
strength of the alloy.5
 Degree of mutilation of crown
 Margin Location The type of retainer on abutment tooth is depended on the
Sound tooth enamel cannot be enhanced biologically or degree, type and size of carious lesion. A caries free and an
esthetically. Therefore, finish lines should not be kept very unrestored tooth is considered as an ideal abutment. For
close to the gingival tissues. The margin of any of any grossly destructed teeth, alterations like dowel core and pin
restorative material if extended beneath the free gingival retained amalgam restorations are required to reinstitute
margin will irritates the gingiva.5 crown shape and form.

 Occlusal anatomy  Pulpal health

Occlusal anatomy has an indirect effect on the forces Vital teeth are usually selected because of their better
directed. The anatomical features like the ridges and grooves proprioceptive feature. Absence of adequate pulpal heath can
enhances the sharpness and shearing action of teeth and lead to failure of the prosthesis. Prophylactic root canal
minimizes the friction between the opposing tooth surfaces treatment may be needed before the restoration.10
by making the contact area narrow. This provides effective
mastication and minimizes the forces transmitted. Stallard  Root configuration
stated that the attrited teeth needs more muscular power and For a short span fixed partial denture the tooth with conical
longer and more masticatory strokes to chew food roots are preferred if all other factors are optimal. Tooth with
efficiently.11 Most of the force is directed perpendicular to the longer root is considered to be a stronger abutment than with
long axis of the teeth. Properly articulated ridge bearing cusps short roots. Labiolingually conical roots are more anchored
will grind the food efficiently, with lesser strokes, with than circular roots. Apical divergence of the root must exceed
minimal muscular effort.10 the apical convergence.12Widely separated multirooted
posterior teeth are more preferred compared to the conical or
 Buccolingual dimension of teeth fused root. On comparison with smooth sided conical roots,
The occlusal surface of the pontics should integrate with the parallel sided roots with developmental grooves exhibits
buccolingual dimensions of the natural unmutilated teeth, and better resistance to additional forces.14
recreate the normal buccal and lingual form to the height of
contour. By reducing the width of the pontics, the forces  Root Proximities
transmitted to the abutments are not decreased, rather it In order to allow the formation of physiologic embrasures in
creates heavier stress per unit on the prosthesis. 2, 12, 13 the completed prosthesis adequate clearance between the
roots of the suggested abutments are necessary. Proper
 Mesio distal dimensions of teeth embrasure form is not possible in cases where the anterior
The total mesiodistal width of the cusps of abutments should teeth are malposed and in the mesiobuccal roots of the
either equivalent or more than the width of the cusps of maxillary molars. In such conditions selective extraction or
pontics. This correlation ensures that the occlusal load root resection procedures may be the only approach to improve
transmitted to the abutment teeth will not be more than twice the longevity of the restoration.5
the amount usually supported by these teeth individually.
 Alveolar Ridge Form
 Pontic - tissue contacts The ideal ridge configuration should be flat and wide.
The tissue-contacting surface on pontics should be Extreme resorption results in the development of low and thin
convex, smooth, and devoid of porosity. The contacting areas ridges, accompanying high pontics and additional torsional
should be minimal, pressure less, and should have saliva forces.5
contact rather than tissue contact.

 Span length

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Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Bending or deflection is equivalent to the cube of the For mentally disabled patients multiple splinted
length with the cube of the occlusogingival thickness of the abutments may be required. Splinted abutments offer
pontic.1Long-span FPDs creates more flexion. In 1934, distribution of harmful parafunctional forces. 10
Stuteville experimented and proved that
 Prognosis
The prosthesis should last for at least 60% of the time in
the span of 20 years.10

V. CONCLUSION
Fixed partial denture with a two-tooth pontic span will
shows bending or deflection 8 times as compared with a single Abutment selection influences the longevity of the
tooth pontic span. Likewise a three-tooth pontic will bend 27 prosthesis. They withstand the forces of mastication. To
times compared to a single pontic. conclude, the necessity of selecting an appropriate abutment
for the fixed partial denture cannot be exaggerated.It forms
This flexure can be reduced by: the foundation for the treatment planning for fixed partial
 Increased occlusogingival thickness of pontics dentures and the proper selection and tooth preparation aids
 Bulky pontics in longevity of the prosthesis.
 Bulky connectors
 Materials with high yield strength REFERENCES

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