Proximal contour modications for xed partial dentures: A clinical report
David A. Kaiser, DDS, MSD,
a and John D. Jones, DDS b The University of Texas Health Science Center, San Antonio, Texas An often-neglected aspect of xed prosthodontics is the contour of the tooth adjacent to the cast resto- ration. The adjacent surfaces should be surveyed to reveal compatibility with the path of insertion of the restoration. Adjacent contacts may have to be altered to permit the placement of the xed partial denture and to ensure proper contact size/shape and embrasure size. The need for guide planes on teeth adjacent to xed partial denture abutments in xed prosthodontics is described. (J Prosthet Dent 2003;89:344-5.) The importance of proximal contour modica- tions for removable partial dentures is well recog- nized. Guide planes have been well documented in the literature as a key to successful treatment in re- movable partial dentures. 1 Although not emphasized to the same extent, the advantages of contouring proximal surfaces provide advantages in patients with xed partial dentures (FPD). During the diagnostic phase for a crown or FPD, a path of insertion must be determined. 2 The interproxi- mal contact areas should also be analyzed at this time to determine compatibility with the path of insertion. This is applicable to a crown or an FPD (tooth supported or implant supported). CLINICAL REPORT In the rst treatment situation, if an overcontoured tooth is unaltered, the result can be a point contact adjacent to the restoration. After completion of the res- toration, a large gingival embrasure results froma failure to adjust the adjacent tooth (Fig. 1). In the second treatment situation, the adjacent tooth contour has been planned and polished to produce an ideal cleansable gingival embrasure. The nal restora- tion presents a more ideal gingival embrasure (Fig. 2). DISCUSSION Restorations should be contoured to provide home-care accessibility to promote a healthy environ- ment for the gingival papilla. 2 The interproximal con- tact should be an area rather than a point. 3 This con- tact area should provide stability for teeth, as well as the proper size embrasure. 4 The embrasure therefore should not be too small or too large. If it is too large, food may collect. Also, if the patient cleans with an interproximal brush, a large embrasure may not com- press the bristles of the brush and may produce inef- fective cleaning (Fig. 3). An analysis of the adjacent tooth contour of a crown or FPD with a dental surveyor may reveal a situation (because of tipping or crown contour) that should be altered. If is not altered to be compatible with the path of insertion of the restoration, a large embrasure and point interproximal contact may result. After analysis of the adjacent tooth and alteration of that surface to pro- duce a surface compatible with the path of insertion, a smaller, more cleansable embrasure and area interprox- imal contact should result. a Professor, Department of Prosthodontics. b Professor, Department of Prosthodontics. Fig. 1. A, Analyzing rod represents path of insertion of adja- cent restoration. Large gingival embrasure will result without guide plane. B, Large gingival embrasure resulting from min- imally altered adjacent contour. 344 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 89 NUMBER 4 SUMMARY Advantages of recontouring tooth surfaces adjacent to xed prosthodontic restorations have been described. By analyzing the contour of adjacent teeth with a dental surveyor prior to fabrication of a crown or FPD, the tooth may be prepared to allow a proper contact area, as well as gingival embrasure. REFERENCES 1. Henderson D, Seward TE. Design and force distribution with removable partial dentures: a progress report. J Prosthet Dent 1967;17:350-64. 2. Shillingburg HT, Jacobi R, Brackett S, Hobo S, Whitsett LD. Fundamentals of xed prosthodontics. 3rd ed. Chicago: Quintessence Publishing; 1997. p. 124-6, 338-40. 3. Schluger S, Yuodelis R, Page RC, Johnson RH. Periodontal diseases: Basic phenomena, clinical management, and occlusal and restorative interrela- tionships. 2nd ed. Philadelphia: Lea & Febiger; 1989. p. 63-4. 4. Malone WFP, Koth DL. Tylmans theory and practice of xed prosthodon- tics. 8th ed. St. Louis: Medico Dental Media International; 1989. p. 592-4. Reprint requests to: DR DAVID A. KAISER DEPARTMENT OF PROSTHODONTICS DENTAL SCHOOL UT HEALTH SCIENCE CENTER 7703 FLOYD CURL DR SAN ANTONIO, TX 78284-7912 FAX: 210-567-6376 E-MAIL: kaiser@uthscsa.edu Copyright 2003 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2003/$30.00 0 doi:10.1067/mpr.2003.72 Fig. 2. A, Planed and prepared adjacent contour will produce normal, cleansable gingival embrasure. B, Final restoration with normal gingival embrasure. Fig. 3. Over-contoured tooth may produce point interproxi- mal contact with large embrasure (A). Contouring guide plane on adjacent tooth can create normal relationship (B). KAISER AND JONES THE JOURNAL OF PROSTHETIC DENTISTRY APRIL 2003 345