Fracture of a fixed partial denture abutment: A clinical report

Ronald G. Verrett, DDS, MS,a and David A. Kaiser, DDS, MSDb

Department of Prosthodontics, University of Texas Health Science Center at San Antonio
Dental School, San Antonio, Texas
Commonly observed complications associated with a conventional fixed partial denture (FPD) include
loss of retention and tooth fracture. This report describes the occurrence of an unusual FPD abutment
fracture and subsequent treatment. The distal abutment of an FPD developed severe periodontal disease
with mobility. The anterior abutment fractured in the middle of the clinical crown and experienced
cement failure. (J Prosthet Dent 2005;93:21-3.)

ixed partial dentures (FPDs) have been shown to

exhibit clinical complications due to a wide variety of
factors. In a review of the literature, Goodacre et al1
identified the most common FPD complications as caries, need for endodontic treatment, loss of retention, esthetics, periodontal disease, tooth fracture, and
prosthesis fracture. In that review, fracture of an abutment tooth occurred in 3% of prostheses.
The technical and biomechanical complications for
FPDs may result in loss of retention, abutment tooth
fracture, and prosthesis fracture. Technical failures occur
more frequently in FPDs with at least 1 cantilever extension pontic, with the rate of failure increasing as the
length of the cantilever span increases.2,3 Fracture of
an FPD abutment adjacent to a cantilever has been reported to occur twice as frequently as fracture of an
abutment not adjacent to a cantilever.4 Abutment fractures in conventional FPDs have also been documented
in longitudinal clinical studies5; however, abutment
fracture of the type reported here is infrequent.6,7 This
clinical report describes an unusual fracture of an FPD
abutment that occurred within the retainer of a conventional FPD and the subsequent treatment.

CLINICAL REPORT
A 69-year-old woman reported to the University of
Texas Health Science Center at San Antonio Dental
School clinic with a chief complaint that the bridge
on the upper right side was loose. The patient reported
that the FPD had been inserted 12 years ago (Fig. 1).
The FPD was found to be loose at the anterior abutment
(maxillary right second premolar) but remained cemented on the distal abutment (maxillary right second
molar). Clinical and radiographic examination revealed
that the distal abutment had periodontal probing depths
of 8 to 9 mm and exhibited Class III mobility (Fig. 2).
The FPD was successfully removed and the maxillary
right second premolar abutment was found to be fractured in the middle of the clinical crown, between the
a

Assistant Professor.
Professor.

JANUARY 2005

Fig. 1. Maxillary right posterior FPD at time of insertion (12

years previous).

occlusal surface and the finish line of the preparation

(Fig. 3). This abutment had remained asymptomatic despite the fracture of the coronal tooth structure. The
margin remained intact around the circumference of
the preparation. The patient was informed of the clinical
findings and was advised that the maxillary right second
molar was not restorable due to severe periodontal pathology. The maxillary right second premolar had a widened periodontal ligament space (Fig. 3), which is often
indicative of occlusal trauma. This finding was related to
the tipping forces transmitted to this abutment during
occlusal loading of the mobile distal abutment of the
FPD. It was noted that the mandibular right first molar
contacted the distal marginal ridge area of the retainer
on the maxillary right second premolar. The possibility
of supraeruption of an unopposed mandibular second
molar and diminished masticatory ability on the right
side of the arch following extraction of the maxillary second molar was discussed. Treatment options were presented that included replacement of the maxillary right
molars with a removable partial denture (RPD) or with
implant-supported crowns that would likely require adjunctive osseous augmentation. The patient declined the
implant option owing to financial considerations as well
as the RPD option because she did not want to wear a removable prosthesis. The patient stated that her desire
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Fig. 2. FPD at time of patient presentation with distal

abutment exhibiting 8 to 9 mm periodontal probing depths
and Class III mobility.

VERRETT AND KAISER

Fig. 3. Removal of FPD revealed horizontal fracture through

anterior abutment.

Fig. 4. Maxillary right second premolar received endodontic

treatment and prefabricated dowel with core foundation. FPD
was sectioned and premolar crown was recemented.

was to retain the maxillary second premolar and to have

the second molar extracted.
Endodontic treatment of the maxillary right second
premolar was accomplished to place a dowel-retained
foundation restoration. The most common dowel and
core complication has been reported to be loosening of
the dowel and root fractures.8 Root fractures have been
reported to account for 3% to 10% of dowel and core
complications, and cemented dowels have been found
to cause the least intraradicular stress.8 A prefabricated
passive parallel dowel (ParaPost Plus; Coltene/
Whaledent, Cuyahoga Falls, Ohio) was adapted to the canal space and cemented with glass ionomer cement
(Ketac-Cem; 3M ESPE, St. Paul, Minn). A prefabricated
post was selected because it was less expensive and did not
require the additional appointment needed to restore the
second premolar with a custom-cast dowel. According to
Summitt et al,9 prefabricated dowels have been shown to
exhibit greater fracture resistance than custom-cast dowels in laboratory studies and to provide a more favorable
prognosis in retrospective clinical studies.
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Fig. 5. Increased mobility of distal abutment (A), combined

with occlusal forces (B), created shear forces between
abutment anterior abutment and axial walls of retainer. These
forces may result in fracture of abutment (C).

The FPD was then sectioned at the interproximal embrasure between the maxillary second premolar and the
first molar, and the resultant second premolar crown was
repolished. The crown was placed on the tooth and marginal integrity was clinically confirmed. A core foundation of the coronal portion of the maxillary right
second premolar was accomplished using an autopolymerizing hybrid, filled resin composite, reinforced
with titanium (Ti-Core; Essential Dental Systems,
Hackensack, NJ). The resin composite was placed on
the tooth and the crown was fully seated, shaping the
core foundation and simultaneously cementing the
crown (Fig. 4). The nonrestorable maxillary second molar was extracted.
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DISCUSSION
This clinical report describes the catastrophic failure
of an FPD. The etiology was severe periodontal disease
localized to the maxillary second molar that permitted
excessive forces on the second premolar abutment. A
biomechanical challenge was created when the excessively mobile distal abutment was rigidly connected to
an abutment with only limited physiologic mobility.
When an excessively mobile FPD abutment is subjected
to an occlusal force, a torquing force is created on the
other abutment that may result in cement failure or fracture of the abutment (Fig. 5). The forces transmitted to
the anterior abutment in this instance are similar to the
forces that occur on a cantilever FPD abutment adjacent
to the cantilever section when the cantilever is subjected
to occlusal loading.

SUMMARY
An FPD abutment may fracture or the cement within
a retainer can fail when subjected to excessive forces.
Fortunately, retrospective clinical studies of conventional FPD complications have concluded that abutment fracture of the type reported is infrequent.
REFERENCES
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long-term function. A longitudinal clinical study. Swed Dent J 1989;13:
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241-55.
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Odontol Scand 1991;49:35-40.
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545-52.
7. Cheung GSP, Dimmer A, Mellor R, Gale M. A clinical evaluation of conventional bridgework. J Oral Rehab 1990;17:131-6.
8. Goodacre CJ, Spolnik KJ. The prosthodontic management of endodontically treated teeth: a literature review. Part 1. Success and failure data,
treatment concepts. J Prosthodont 1994;3:243-50.
9. Summitt JB, Robbins JW, Schwartz RS. Fundamentals of operative dentistry.
2nd ed. Carol Stream (IL): Quintessence; 2001. p. 551.
Reprint requests to:
DR RONALD G. VERRETT
DEPARTMENT OF PROSTHODONTICS
UTHSCSA DENTAL SCHOOL
7703 FLOYD CURL DRIVE, MSC 7912
SAN ANTONIO, TX 78229-3900
FAX: 210-567-6376
E-MAIL: verrett@uthscsa.edu
0022-3913/$30.00
Copyright 2005 by The Editorial Council of The Journal of Prosthetic
Dentistry.

doi:10.1016/j.prosdent.2004.10.009

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