Complications And Management In

Fixed Partial Dentures

Spring Semester 2025

Dr.Tabarak Challoob
Email: [email protected]
Learning objectives
At the end of this lecture, student is expected to:
• List the types of common complications that may occur in relation to
FPDs
• Describe the pre-insertion and post-insertion types in detail, how to
identify and how to avoid
• Describe long term complications and management of some
complications
• List, justify and know how to manage the various types of failures that
may be encountered in FPDs

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COMPLICATIONS a) Failure to seat
• Common immediate pre- b) Lack of adaptation
insertion problems c) Premature contacts
d) Very tight contacts
e) Open contacts
f) Blanching of tissues
• Post insertion problem underneath pontic area

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 Immediate pre-insertion problems

Check:
1. Proximal contacts
2. Marginal integrity
3. Retention & Stability Evaluation sequence of
4. Occlusion the seated crown
5. Polishing or characterization and glazing
{Esthetics}

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 Common immediate pre- insertion problems
Marginal deficiencies
 Positive ledge (overhang)

 Negative ledge (open margin)

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Poor fitting margins will lead to:
• Cement dissolution
• Plaque retention and affect the health of gingiva
• Recurrent caries
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 Defective
Margin

Tooth

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 To check the marginal integrity of
the crown restoration
This indicate for the supra gingival margin or margin that have easy
access to evaluate by the operator eyes that might be:
Visual
 Direct or indirect visual (mirror)
 Use of Magnification apparatus such as eye loops or microscope.

 Use to detect Interproximal margins that cannot seen by eye

Radiographic
 Angle of beam (parallel technique to detect interproximal margin)

 Probe to check the marginal integrity of the crown restoration,

Explorer especially subgingival margin, varying tip size probes should be used.
Varying approaching angle should be applied during checking with probe.

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Grinding And Polishing
In Situ

• Metal margins of crowns

with positive ledges

• Porcelain margin
• Heatless stone
• Diamond point
• Followed by various
composite finishing burs
and discs

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Metal margins
• Diamond stone
• Green stones
• Tungsten carbide stones
• Metal and linen strips
• Interdentally,
• Triangular shaped
diamond
• Abrasive rubber
instrument with special
handpiece
• Margins should be polished

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The Inter Proximal Contact Area

Dental floss - to check the interproximal contact by

passing it between the restoration and the adjacent
natural teeth, there should be slight resistance

a) Heavy resistance; the dental floss can’t pass

through the contact, this indicate that the contact is
too tight
b) No resistance; if the floss passes easily, it indicate
that the contact area is under contoured (deficient
contact).

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 How To Correct
A metal crown or retainer with a deficient proximal contact can usually either
you have to repeat the restoration or to correct this defect by adding solder to that
area.
Porcelain restoration
• The area of contact can be identified with red pencil or thin marking tape.
• A tight proximal contact in unglazed porcelain is easily adjusted with a
cylindrical stone.
• If adjustment of a glazed restoration is needed, it can be done with diamond
impregnated silicone points or diamond polishing paste
• A deficient proximal contact correct by adding porcelain (lab)

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Blanching Of Blanching of tissues beneath an
abutment or pontic area occurs when
Tissues Underneath excessive pressure is applied to the gum
tissue, causing it to turn pale due to
Abutment Or Pontic restricted blood flow. This can result from
improper fitting of dental restorations or
Area excessive pressure during placement.

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 Post Insertion Problem
• Complications
• Failures

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Complications In FPD
•3 most commonly reported
complications were:
• Caries,
• Need for endodontic
treatment, and
• Loss of retention

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 Failures of the FPDs

• Irreversible complications (loss of FPD/abutment)

• Reversible complications (FPD intact after conservative treatment)

• Biologic and technical/patient-related.

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Clinical Complication Rates
(Evidence Based)

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 Clinical complications in fixed prosthodontics
• The lowest incidence of clinical complications was associated
with all-ceramic crowns (8%).
• Posts and cores (10%) and conventional single crowns
(probably including PFM or metal) (11%) had comparable
clinical complications incidences.
• Resin-bonded prostheses (26%) and conventional fixed partial
dentures (27%) were found to have comparable clinical
complications incidences.
Sailer I, Makarov NA, Thoma DS, Zwahlen M, Pjetursson BE. A systematic review of the survival and complication rates of
fixed dental prostheses (FDPs) after an observation period of at least 5 years. J Dent. 2015;43(8): 1–16.
doi:10.1016/j.jdent.2015.01.005 19
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 Incidence Of Clinical Complications With Conventional
Fixed Partial Denture Prosthesis :
• Caries (18% of abutments and 8% of prostheses had complications because of the
caries)
• Need for endodontic treatment (11% of abutments and 8% of prostheses needed
RCT )
• Loss of retention (7% of prostheses)
• Esthetics (6% of prostheses)
• Periodontal disease (4% of prostheses)
• Tooth fracture (3% of prostheses)
• Prosthesis/porcelain fracture (2% of prostheses)
Sailer, I., Makarov, N. A., Thoma, D. S., Zwahlen, M., & Pjetursson, B. E. (2015).
A systematic review of the survival and complication rates of fixed dental prostheses (FDPs) after an observation period
of at least 5 years.
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Incidence Of Clinical Complications In All-
ceramic Crowns
• Crown fracture: (7%)
• Loss of retention (2%)
• Need for endodontic treatment (1%)
• Caries (0.8%)

Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in
fixed prosthodontics. Journal of Prosthetic Dentistry, 90(1), 31–41.

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 Incidence of Clinical complications in post and core :

• Post loosening (5%)

• Root fracture (3%)
• Caries (2%)
• Periodontal disease (2%)

Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in
fixed prosthodontics. Journal of Prosthetic Dentistry, 90(1), 31–41.
https://doi.org/10.1016/S0022-3913(03)00214-2

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Incidence Of Clinical Complications With
Conventional Single Crowns :
• Endodontic treatment (3%)
• Porcelain fracture (3%)
• Loss of retention (2%)
• Periodontal disease (0.6%)
• Caries (0.4%)

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Incidence Of Clinical Complications With
Resin Bonded Prosthesis :
• Debonding (21% of prostheses)
• Tooth discoloration (18% of prostheses)
• Caries (7% of prostheses)
• Porcelain fracture (3% of prostheses)

Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in fixed
prosthodontics. Journal of Prosthetic Dentistry, 90(1), 31–41. https://doi.org/10.1016/S0022-
3913(03)00214-2
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 Biological
Complication/ Mechanical/ technical
Failure Design
Esthetic
Functional

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 Biological complications
• Caries,
• Pulp degeneration
• Loss of vitality
• Periodontal disease recurrence/ breakdown
• Occlusal problem *
• Tooth and Material fractures / perforation

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 • Indicate A slow progressive tissue degeneration
induced by the procedure or
• Reflect the increased susceptibility of pulpal
infection by dentinal tubules in advanced
Loss Of Vitality periodontitis (bergenholtz & nyman 1984).
• Pulpal necrosis was diagnosed primarily on the
basis of the presence of periapical radiolucency
and found a higher incidence of pulpal necrosis in
abutment teeth.

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 Loss Of Retention
Clinical conditions with excessive taper and short clinical crowns
should be treated with :
In case of excessive taper:
• Incorporation of proximal grooves.
• Additional retentive grooves (should be along with the path of
insertion).
• Additional pins

In case of short crowns :

• Crown lengthening procedure
• Modification of supra-gingival margin to sub-gingival margin
• Additional retentive grooves and proximal box
• Incorporation of pins
• Addition of extra abutments may be needed
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Abutment Tooth Occurred in distal extension FPD
abutments on non-vital and root treated
Fracture
abutments.

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Vertical Root Fracture

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 Differential Diagnosis
1.External Cervical Resorption:
Irregular radiolucency at cervical
root; most likely.
2.Root Fracture: Sharp, defined
radiolucent line; usually post-
trauma.
3.Root Caries: Cervical decay,
often in patients with gingival
recession.
4.Internal Resorption: Smooth
radiolucency from within the canal.
5.Iatrogenic Perforation: Due to
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 Treatment Sequence Before Bridge Placement

Comprehensive Assessment
– Clinical and radiographic exam (restorability, pulpal/periodontal status, occlusion).
Initial Periodontal Therapy
– Scaling and root planing.
– Oral hygiene instructions.
– Re-evaluate periodontal condition after healing.
Caries Removal & Restorability Check
– Remove decay to assess tooth structure.
– Decide on restorability and need for post & core.
Endodontic Treatment (if needed)
– Root canal therapy for non-vital/compromised teeth.

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Core Build-Up
– Reconstruct tooth with or without post depending on structure loss.
Definitive Periodontal Procedures (if needed)
– Crown lengthening or gingivectomy for biologic width/ferrule.
Provisional Restoration
– Temporary bridge to protect preps and contour gingiva.
Bridge Design & Planning
– Select material, design, and confirm abutment support.
Tooth Preparation & Final Impression
– Final tooth prep, soft tissue management, impression.
Try-in & Final Cementation
– Check fit, esthetics, occlusion; final cementation.
Maintenance & Recall
– Hygiene support and periodic evaluation of bridge.
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 Mechanical failures (Technical)

• Loss of retention (fracture of the luting cement)

• Fracture of the abutment teeth leading to FPD loss
• Connector failure
• Occlusal wear
• Material complications:
framework, veneer and core fractures
Porcelain fracture
Acrylic veneer wear/ loss

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 Porcelain Repair (Porcelain fused to metal
crown )With Composite (for optimal results:
isolate with rubber dam)
•Etch porcelain/metal surface with 4% hydrofluoric acid for 4 minutes.
•Rinse and dry thoroughly.
•Apply one coat of Porcelain Primer (Silane) to exposed porcelain.
•Light cure for 10 seconds.
•Mix equal amounts of dual cure Opaquer Base & Catalyst.
•Apply thin layer on exposed metal surface to mask out metal shine-through.
•Light cure for 10 seconds.
•Use the composite of choice and light cure in small increments or use a
microhybrid composite.
•Proceed with finishing and polishing.

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Aesthetic failures
• Shade mismatch
• Crowns too opaque
• Crowns too big or too small
• Unnatural contours
• Visible margins
• Black triangles

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 Functional failures

• Inability to chew
• Loosening of crowns/FPD
• Food impaction
• Pain on biting
• Improper occlusion

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 Management
1. Leave it alone if not causing any serious harm - monitor
2. Adjusting or repairing the fault
3. Replace the crown or bridge

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 When intact and should be cut off.

A vertical groove is made with a diamond bur in

Removing FPD the buccal surface just through to cement.

Then removed with suitable heavy-duty

instrument.

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 Possible to remove with normal devices
Usually better to cut off.
Cast metal
Solid tungsten carbide bur with very fine cross
Removing metal – cuts
ceramic crowns Eye protection!!!
Vertical groove cut on buccal
Metal is usually thinner here
 With better vision.

Diamond bur can cut

Porcelain favorably !

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How To Cut A PFM
Crown or Bridge
Diamond for ceramic
TC for metal

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• Many failures occur because of poor diagnosis and fail to plan
• The four major diagnostic aids to making a dental diagnosis
are :
• Taking a history
• Careful clinical examination
• Relevant radiographs
• Diagnostic casts correctly mounted.
Fail to plan
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 Conclusion
• The first consideration when confronted with any failure or repair situation is to
ascertain the cause or suspected cause.
• If there is a cause that is correctable it should be taken care of first. Care should be
taken not to become involved in repairs that should have been remakes. Repairs are
usually second best to the original in one or more ways.
• Most failures are unique and present varying challenges to the dental specialist.
• Great satisfaction can be achieved in meeting a situation and solving it in an
effective and economical manner.

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