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Bridge Failures

Technology in the hands of a skilled operator makes it possible to


do more work of an even higher quality. But in the hands of one who has
not mastered the skills of his or her profession, that technology merely
enables one to do tremendous damage.
-

Herbert T. Shillingburg

Excellence in dental care is achieved through the dentists ability


to assess the patient, determine needs, design an appropriate treatment
plan and execute the plan with proficiency.

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Chief among the causes for bridge failures have been:

1. Faulty, and
2. Failure

in some cases, no attempt at diagnosis and prognosis

to remove foci of infection and

and care of the investing

3. Disregard
4. Absence

6. Faulty

tissues and mouth sanitation

for tooth form

of proper embrasures

5. Interproximal

inattention to treatment

spaces

occlusion and articulation

TYPES OF BRIDGE FAILURES

Cementation failure

Mechanical failure

Gingival and periodontal breakdown

Caries

Necrosis of pulp

Esthetic failure

CEMENTATION FAILURE

Cement failure

Retention failure

Occlusal problems

Distortion of the bridge

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Cement Failure

Cement selection

Old cement

Prolonged mixing time

Thin mix

Thick mix

Cement setting prior to seating

Inadequate isolation

Incomplete removal of temporary cement

Thick cement space

Inclusion of cotton fibers

Insufficient pressure while cementation

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Cement Selection

FPD Multiretainers - GIC

Non Vital Teeth/Advanced Pulp Recession -

Temporary Cementation - ZINC OXIDE EUGENOL

Fixation of Facings- DIMETHACRYLATE COMPOSITES

Abutment with Minimal Dentin / Exposure- CALCIUM HYDRO


OXIDE + ZINC OXIDE EUGENOL

ZINC PHOSPHATE

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Thick Cement Space

Convergence below 6

Excessive application of die spacer

Thick cement mix

Grinding metal inside retainers

Thick cement mix

Cement setting prior to seating

How to Confirm Cement Failure

Pull the crown margin and see for movement of the crown

Crown margins which were subgingivally placed will be visible


when we pull the crown margin

Bubbles come out of the margin or through perforation of the crown


(if present) when the crown margin is pushed by applying pressure
occlusally

RETENTION FAILURE

Excessive taper

Short clinical crown

Mis-fit

Mis-alignment

Retention

Retention prevents the removal of the restoration along the path of


insertion or the long axis of the tooth.

Resistance prevents dislodgement of the restoration by forces


directed in apical or oblique direction

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Excessive Taper

The relationship of one wall of preparation to the long axis of that


preparation is the inclination of that wall.

Sum of the inclination of two opposing walls give the taper of the
preparation.

Minimum 12 taper is necessary to ensure the absence of undercuts

& also the restoration is placed on the preparation after being


fabricated in final form.

Conscious effort to incorporate taper usually results in over tapered,


non retentive preparation.

Short Clinical Crown

Cement creates a weak bond, largely by mechanical interlocks,


between the inner surface of the restoration & the axial wall of the
preparation. So, greater the surface area of preparation, greater
wills the retention.

A short, over tapered crown would have minimal retention because


the restoration can be removed along infinite paths.

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Because the length of axial wall occlusal to finish line interferes


with the displacement, the length & inclination become important
factors.

Improving Retention

Additional retentive grooves/ proximal grooves.

Additional pins- drill the retainer & tooth .5 to .7 mm with round


bur in buccal & lingual aspects, cut the excessive length &
smoothen the area.

Crown lengthening

Sub gingival margins

Additional abutments

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Misfit
Causes-

Expansion of metal substructure because of

-Improper water /powder ratio of investment


-Improper mixing time
-Improper burn out temperature

Distortion of the margins

Distortion of metal substructure

Metal bubbles in occlusal or margin regions because of

- Inadequate vacuum during investing


- Improper brush technique

No surfactant

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Porcelain inside retainer

Excessive oxide layer in inner side of retainer

Tight contact points

Thick cement space

Insufficient pressure during cementation

Misalignment

In case of misalignment the bridge will ve some spring in it & tend


to seat further on pressure due to abutment teeth moving slightly

In misfit the resistance felt is solid.

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Causes

Abutment displacement due to improper temporization.

Distortion of wax pattern

Casting defects

Distortion of metal framework in porcelain firing.

Porcelain flow inside the retainers

Mal alignment of solder joints

Excessive metal or porcelain in tissue

surface of pontic.

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Remedy

If the bridge seats fully under pressure- leave it in place for 30 min
to 1 hr asking the patient to exert gentle pressure.

If it does not work, temporarily cement to one of the retainers for 1


to 2 days.

Then, the bridge is unsoldered, separate components tried. If they


seat, take location impression & resolder.

Occlusal problems
Torque

From a cusp extended too far bucally or lingually.

Pre mature contact on lateral excursion extremity.

Results in cementation failure.

Reduce bucco lingual width of occlusal surface

Indications

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Mobility of teeth

Tenderness on mastication

Hyperemia of soft tissues

Sensitivity to heat, cold & sweet

Burnished metal in area of premature contact

Checking occlusion

Touch

Thin articulating paper

Occlusal indicator wax

Occlusion should be adjusted both in centric and eccentric

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Distortion

Distortion of wax patterns

Incomplete casting

Long span bridges

Wax Patterns

Removal from the die

Spruing stage

Investing stage because of the thick investment material.

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Incomplete Casting

Too thin wax patterns

Incomplete wax elimination

Cool mold or melt

Insufficient metal

Long Span Bridges

Thin crown

Soft metal

Heat treatment not being done

Porosity in the metal

Distortion of margins

MECHANICAL FAILURE

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1. Retainer failure
2. Pontic failure
3. Connector failure

Retainer Failure
Perforation

Insufficient occlusal reduction

High points in opposing dentition

Premature contacts

Soft metal

Porosity

Para functional habits

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Marginal Discrepancy
The more accurately the restoration is adapted to tooth, the less will
be chances of cementation failure, recurrent caries or periodontal disease.
50 to 100 discrepancy is acceptable.

Rough margins reduce adaptation

Open margins encourage entry of saliva and cariogenic organisms

Over extended margins can not be adapted to converging convexity


of tooth at cervical margin

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Causes-

Selection of margin

Improper preparation

No gingival retraction

Improper selection of impression material

Distortion of wax patterns

Nodules at margin or inside casting

Thick cement

Prior setting of cement

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Facing Failure
Fracture

Too little retention

Spot contact at porcelain metal junction

Malocclusion

Microleakage

Wearing

Deep bite

Acrylic veneering opposing porcelain teeth

Faulty brushing & flossing

Parafunctional habits

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Discolouration

Absorption of oral fluids

Absorption

of

artificial

food

colouring

agents

through

the

microcracks or microleakage in metal & facing

Tarnish of underlying metal & facing

PONTIC FAILURE
Requirements

Form & shape of gingival surface must not irritate residual ridge

Design must incorporate mechanical principles for strength &


longevity

Esthetics

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Residual Ridge Contour

Ideal - smooth, eas y to clean

Irregular hyperplastic tissue (commonly because of an ill fitting


rpd) must be surgically removed

Severe bone resorption (particularly because of trauma)- surgical


ridge augmentation

Ridge Contact

Pressure free contact without blanching.

In esthetic zone, the pontic should contact on the labial/ buccal


aspect.

In mandibular posteriors hygienic pontic can be given.

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Metal Sub Structure is compromised Due to-

Limited edentulous space in Occluso gingival direction due to supra


eruption of opposing tooth.

Limited space mesiodistally due to drifting of adjacent teeth

Framework must provide uniform thickness for porcelain- cut back


wax uniformly

Metal ceramic junction should be 1.5 mm away from junction.

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GINGIVAL AND PERIODONTAL BREAKDOWN
Supra Gingival Margins
Advantages

Can be easily finished

Easily cleanable

Impressions easily recordable

Eas y evaluation at recall

Disadvantages

Esthetically inferior

Not indicated for short clinical crowns

Not indicated in case of root sensitivity

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Sub Gingival Margins
Indications

Esthetic demands

Caries removal

Existing sub gingival restorations

Crown lengthening

Disadvantages

Difficult to prepare

Soft tissue prone to trauma

Causes gingival & periodontal pathosis

Difficult oral hygiene

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Metal margins seen through gingiva

CARIES

Caries occuring on the margin of the retainer,

Caries affecting indirectly by starting elsewhere on the tooth and


spreading.

Caries due to cementation failure.

NECROSIS OF PULP

Speed, size, and type of the rotating instrument

The amount of pressure used

Depth of remaining dentin

Vibration

Coolants

Desiccation

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Chemical injury

ESTHETIC FAILURES
Requirements for Esthetic Restorations

Proper shade selection

Correct tooth preparation

Final impression

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Reasons for Esthetic Failure

Failure to identify patient expectations regarding esthetics

Improper shade selection

Failure to transfer shade selection to laboratory

Excessive metal thickness at incisal and cervical regions

Over glaze or too much smooth surface

Metal exposure in connector, cervical, and incisal region

Dark space in cervical third due to improper pontic selection


(anteriors)

Failed to produce incisal and proximal translucency

Improper contouring

Failure to harmonize contra-lateral tooth morphology- contour,


colour, position, angulations

Discoloration of facing

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Shade Selection

Walls and surroundings should be in neutral colour or blue

Never select under direct sunlight

Upright position of the patient

Use squint test

Teeth should be clean and unstained

Shade selection should be done before teeth preparation

Dont dry the tooth while selecting the shade

Canine is the darkest tooth

Premolars lighter shade than canine

Maxillary anteriors are missing, shade of the mandibular anteriors is


considered

In case of a non-vital tooth, cover it and select the shade of the


adjacent tooth

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REFERENCES
Shillingburg HT, Hobo S, Whitsett LD, Jacobe R, and Brackett SE:
Fundamentals of fixed prosthodontics, ed. 3, Chicago, 2001, Quintessence,
Inc.
Roberts DH: Fixed bridge prosthesis, ed. 1, Bristol, 1973, John Wright &
Sons.
Rosenstiel

SF,

Land

MF

and

Fujimoto

prosthodontics, 2001, ed. 3, N.Delhi, Harcourt.

J:

Contemporary

fixed

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